Can Pulmonary Arterial Pressure Exceeding 15 mm Hg Predict Prognosis in Patients With a Single-Ventricle Defect Undergoing the Glenn Procedure?

The primary goal of the Fontan reconstructive surgery is not only to achieve optimal systemic blood flow and simultaneous controlled pulmonary balance but also to prevent the blood from returning to the ventricles. Such measures as the use of systemic-pulmonary shunts can help achieve the desired outcome in this type of surgery. It appears that reducing the resistance of pulmonary arteries and maintaining pulmonary arterial pressure (PAP) could serve as prognostic factors in patients undergoing this surgery. We sought to test the hypothesis that preserved PAP in patients with a single-ventricle defect undergoing the Fontan procedure via the Glenn shunt implantation could confer a better prognosis.  This retrospective cohort study was conducted on 54 consecutive patients with a single-ventricle defect who underwent the Glenn procedure in Rajaie Cardiovascular Medical and Research Center in Tehran in 2019. Based on PAP assessed by angiography, the patients were classified into 2 groups: PAP equal to or less than 15 mm Hg (n=27) and PAP above 15 mm Hg (n=27). Information on the surgical outcome was compared between the 2 groups.  No difference was observed between the groups in the rate of cardiac arrhythmia (P=0.192), but the prevalence rates of ascites (7.4% vs 48.1%; P=0.001) and pleural effusion (33.3% vs 85.2%; P=0.001) were higher in the high-PAP group. The mean length of hospital stay (6.00±2.37 d vs 9.48±6.86 d; P=0.16) and the mean length of ICU stay (3.93±1.07 d vs 5.30±2.30 d; P=0.008) were longer in the high-PAP group.  High PAP is regarded as a prognostic factor in patients undergoing the Glenn procedure since it places patients at risk for postoperative ascites and pleural effusion and, thus, the need for long-term hospitalization. (Iranian Heart Journal 2022; 23(1): 112-117)