Impact of Antegrade Pulmonary Blood Flow as Patients Progress through Single Ventricle Palliations.

BACKGROUND: The impact of antegrade pulmonary blood flow (APBF) during single-ventricle (SV) palliation continues to be debated. We sought to assess its impact on the hemodynamic profile on the short- and long-term outcomes on patients progressing through stages of SV-palliation.

METHODS: Retrospective single-center study of SV-patients who underwent surgery between January/2010 and December/2020. Patients with APBF were matched to those with no-APBF using a propensity score based on BSA, sex, and type of systemic-ventricle. Analysis was performed using appropriate statistics with a significance level of p=0.05.

RESULTS: Sixty-three patients with APBF were matched with 95 patients with no-APBF at the prestage-2 catheterization, APBF patients had a larger left pulmonary artery (PA) diameter (z-score 0.1 vs -0.8, p<0.042). Patients with APBF had shorter CPB-time (57.0 vs 79.0 minutes), shorter duration of mechanical ventilation (MV) (14.1 vs 17.4 hours), and shorter hospital length of stay (LOS) (5.0 vs 7.0 days) at stage-2 palliation (p<0.05). In the multivariable cox regression analysis, patients with hypoplastic PAs (z-scores <-2) (aHR 9.17), and patients with chromosomal abnormalities/genetic syndrome (aHR 4.03) were at increased risk for poor outcomes (p<0.05). Over the follow-up period, there was no significant difference in risk of the composite poor outcome, and long-term survival between groups.

CONCLUSIONS: SV-patients with APBF had shorter CPB-time, duration of MV, and hospital LOS after stage-2 palliation. Patients with hypoplastic PAs or chromosomal abnormalities/genetic syndromes had increased risk for poor outcomes. Maintaining APBF has better short-term outcomes, but there are no long-term hemodynamic or survival benefits.