Single Ventricle Palliation in a Developing Sub-Saharan African Country: What Should be Improved?. Issue 2 (March 2019)

• Record Type: Journal Article
• Authors: Manuel, Valdano; Morais, Humberto; Turquetto, Aida L. R.; Miguel, Gade; Miana, Leonardo A.; Pedro, Albino; Nunes, Maria A. S.; Leon, Gilberto; Magalhães, Manuel Pedro; Martins, Telmo; Júnior, António P. F.
• Is Part Of: World journal for pediatric & congenital heart surgery. Volume 10:Issue 2(2019)
• Page Start: 164
• Page End: 170
• Publication Date: 2019-03
• Subjects: single ventricle -- Fontan procedure -- Glenn procedure -- Blalock–Taussig shunt -- pulmonary artery banding; Pediatric cardiology -- Periodicals; Congenital heart disease in children -- Periodicals; Heart -- Abnormalities -- Surgery -- Periodicals; Heart -- Surgery -- Periodicals; Heart Defects, Congenital -- surgery -- Periodicals; Cardiac Surgical Procedures -- Periodicals; Child -- Periodicals; Adult -- Periodicals; 618.9212
• DOI: 10.1177/2150135118822671
• Languages: English
• ISSNs: 2150-1351

Abstract

Introduction: Single ventricle physiology management is challenging, especially in low-income countries. Objective: To report the palliation outcomes of single ventricle patients in a developing African country. Methods: We retrospectively studied 83 consecutive patients subjected to single ventricle palliation in a single center between March 2011 and December 2017. Preoperative data, surgical factors, postoperative results, and survival outcomes were analyzed. The patients were divided by palliation stage: I (pulmonary artery banding [PAB] or Blalock–Taussig shunt [BTS]), II (Glenn procedure), or III (Fontan procedure). Results: Of the 83 patients who underwent palliation (stages I-III), 38 deaths were observed (31 after stage I, six after stage II, and one after stage III) for an overall mortality of 45.7%. The main causes of operative mortality were multiple organ dysfunction due to sepsis, shunt occlusion, and cardiogenic shock. Twenty-eight survivors were lost to follow-up (22 after stage I, six after stage II). Thirteen stage II survivors are still waiting for stage III. The mean follow-up was 366 ± 369 days. Five-year survival was 28.4 % for PAB and 30.1% for BTS, while that for stage II and III was 49.8% and 57.1%, respectively. Age (hazard ratio, 0.61; 95% confidence interval: 0.47-0.7; P = .000) and weight at surgery (hazard ratio, 0.45; 95% confidence interval: 0.31-0.64; P = .002) impacted survival. Conclusion: A high-mortality rate was observed in this initial experience, mainly in stage I patients. A large number of patients were lost to follow-up. A task force to improve outcomes is urgently required.