Impact of Pulmonary Flow Study Pressure on Outcomes After One-Stage Unifocalization

Matteo Trezzi, Sonia B. Albanese, Antonio Albano, Gabriele Rinelli, Carolina D'Anna, Angelo Polito, Enrico Cetrano, Adriano Carotti

Research output: Contribution to journalArticle

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Abstract

Background The purpose of this study was to evaluate the accuracy of the pulmonary flow study in (1) predicting the feasibility of concomitant intracardiac repair after one-stage unifocalization; and in (2) predicting long-term survival and the onset of right ventricular dysfunction after surgery. Methods Between October 1996 and July 2015, a flow study was obtained in 95 patients undergoing complete one-stage unifocalization for pulmonary atresia with ventricular septal defect and major aortopulmonary collaterals. The ability to achieve 100% flow (approximately 2.5 L · min−1 · m−2) into the pulmonary bed at a mean pressure of 30 mm Hg or less was utilized as an indicator for acceptability of ventricular septal defect closure. Results Overall survival was 78% ± 6% at 15 years. Sixty-four patients underwent successful one-stage intracardiac repair. The flow study accurately predicted suitability for VSD closure (area under the curve = 0.855). After one-stage ventricular septal defect closure, no difference in survival was observed after stratification according to flow study pressures (25 mm Hg or less versus greater than 25 mm Hg, log rank p = 0.20). At a median follow-up of 7 years, no association was found between flow study pressure and the onset of right ventricular dysfunction (p = 0.21). Overall, the inability to achieve final intracardiac repair was a strong predictor of death (hazard ratio 9.14, 95% confidence interval: 1.98 to 42.07, p < 0.0001). Conclusions Suitability for ventricular septal defect closure is reliably defined by the flow study with a cutoff of 30 mm Hg. Flow study pressure values do not affect long-term outcomes. The ability to obtain intracardiac repair (in either one or more stages) is the strongest predictor of survival.

Original languageEnglish
Pages (from-to)2080-2086
Number of pages7
JournalAnnals of Thoracic Surgery
Volume104
Issue number6
DOIs
Publication statusPublished - Dec 1 2017

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Ventricular Heart Septal Defects
Right Ventricular Dysfunction
Pressure
Lung
Survival
Area Under Curve
Confidence Intervals

ASJC Scopus subject areas

  • Surgery
  • Pulmonary and Respiratory Medicine
  • Cardiology and Cardiovascular Medicine

Cite this

Impact of Pulmonary Flow Study Pressure on Outcomes After One-Stage Unifocalization. / Trezzi, Matteo; Albanese, Sonia B.; Albano, Antonio; Rinelli, Gabriele; D'Anna, Carolina; Polito, Angelo; Cetrano, Enrico; Carotti, Adriano.

In: Annals of Thoracic Surgery, Vol. 104, No. 6, 01.12.2017, p. 2080-2086.

Research output: Contribution to journalArticle

Trezzi, Matteo ; Albanese, Sonia B. ; Albano, Antonio ; Rinelli, Gabriele ; D'Anna, Carolina ; Polito, Angelo ; Cetrano, Enrico ; Carotti, Adriano. / Impact of Pulmonary Flow Study Pressure on Outcomes After One-Stage Unifocalization. In: Annals of Thoracic Surgery. 2017 ; Vol. 104, No. 6. pp. 2080-2086.
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AU - Polito, Angelo

AU - Cetrano, Enrico

AU - Carotti, Adriano

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AB - Background The purpose of this study was to evaluate the accuracy of the pulmonary flow study in (1) predicting the feasibility of concomitant intracardiac repair after one-stage unifocalization; and in (2) predicting long-term survival and the onset of right ventricular dysfunction after surgery. Methods Between October 1996 and July 2015, a flow study was obtained in 95 patients undergoing complete one-stage unifocalization for pulmonary atresia with ventricular septal defect and major aortopulmonary collaterals. The ability to achieve 100% flow (approximately 2.5 L · min−1 · m−2) into the pulmonary bed at a mean pressure of 30 mm Hg or less was utilized as an indicator for acceptability of ventricular septal defect closure. Results Overall survival was 78% ± 6% at 15 years. Sixty-four patients underwent successful one-stage intracardiac repair. The flow study accurately predicted suitability for VSD closure (area under the curve = 0.855). After one-stage ventricular septal defect closure, no difference in survival was observed after stratification according to flow study pressures (25 mm Hg or less versus greater than 25 mm Hg, log rank p = 0.20). At a median follow-up of 7 years, no association was found between flow study pressure and the onset of right ventricular dysfunction (p = 0.21). Overall, the inability to achieve final intracardiac repair was a strong predictor of death (hazard ratio 9.14, 95% confidence interval: 1.98 to 42.07, p < 0.0001). Conclusions Suitability for ventricular septal defect closure is reliably defined by the flow study with a cutoff of 30 mm Hg. Flow study pressure values do not affect long-term outcomes. The ability to obtain intracardiac repair (in either one or more stages) is the strongest predictor of survival.

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