Abstract 14637: Early Recovery in Patients with Borderline Left Heart Disease after Conversion from a Single Ventricle to a Biventricular Circulation
Introduction: Borderline left heart disease (BLHD) represents a spectrum of left-sided obstructive lesions, LV hypoplasia, and endocardial fibroelastosis. After prior single ventricular palliation, patients with BLHD who undergo later LV rehabilitation and conversion to a biventricular circulation are a management challenge. Here we describe the early postoperative course of this cohort with restrictive LV physiology, and test the hypothesis that LA pressure is associated with ICU resource utilization.
Methods: Records of 21 consecutive patients from 2003 through 2009 with BLHD undergoing conversion from a single to biventricular repair at our institution were reviewed. LA pressure (LAp) at 0, 6, 12, and 24 hours were used to calculate a time-weighted postoperative LAMean. The effects of preoperative LAp by catheterization, LV EDV by MRI, and early postoperative hemodynamic data including LAMean on indices of ICU resource utilization, including time to extubation and ICU length of stay (LOS), were studied.
Results: The median age at biventricular conversion was 2.7 years (range 0.4-7.9) and weight was 12.0 kg (4.0-19.6). Of the 21 patients, 5 (24%) underwent reintervention prior to ICU discharge, and 20 (95%) survived to ICU discharge. There was an inverse relationship between preoperative LAp and time to successful extubation (Spearman r=-0.58, p=0.01). Patients with a preoperative LV EDV by MRI of less than 40 mL/m2 demonstrated a longer time to first extubation [10.1 (8.8-40.5) vs. 2.8 (1.8-6.6) days, p=0.001] and ICU LOS [37.0 (14.0-156.0) vs. 6.8 (3.7-31.9) days, p=0.01]. Patients with a postoperative LAMean of at least 16 mmHg had a greater duration of paralysis [5.4 (4.6-8.6) vs. 1.8 (0.0-6.2) days, p=0.01], time to first extubation [24.9 (6.6-40.5) vs. 4.9 (1.3-13.9) days, p=0.02], reintervention risk (OR 22.7, 95%CI 1.5-333, p=0.03), and ICU LOS [45.8 (14.0-156.0) vs. 9.0 (2.9-99.8) days, p=0.04].
Conclusions: Preoperative indices of LV conditioning and early postoperative LAp are associated with ICU resource utilization following a biventricular repair. Prospective investigation will be necessary to determine the effects of LV rehabilitation on myocardial remodeling and biventricular repair outcomes over time.
- © 2010 by American Heart Association, Inc.