Open Access

ARTICLE

Efficacy of Intravenous Treprostinil in High-Risk Single Ventricle Patients Undergoing Glenn Procedure

Xiaofeng Wang^1,#, Xingwei Chen^2,#, Shilin Wang¹, Xia Li¹, Zhongyuan Lu¹, Wenlong Wang¹, Xu Wang^1,*
1 Department of Pediatric Intensive Care Unit, National Center for Cardiovascular Disease, Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100037, China
2 Department of Pharmacy, National Center for Cardiovascular Disease, Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100037, China
* Corresponding Author: Xu Wang. Email:
# These authors contributed equally to this paper

Congenital Heart Disease https://doi.org/10.32604/chd.2024.054441

Received 28 May 2024; Accepted 18 October 2024; Published online 04 November 2024

Abstract

Objective: Pulmonary hypertension is a crucial factor affecting the recovery after Glenn procedure. This study explores the effects of intravenous treprostinil on hemodynamic status and hospital postoperative recovery under different administration strategies. Methods: We retrospectively included pediatric patients admitted to Fuwai Hospital from 2019 to 2022 who underwent the Glenn procedure and had intraoperative measurements of mean pulmonary artery pressure (mPAP) >15 mmHg postoperatively. Patients with non-anatomical single ventricle physiology undergoing the Glenn procedure and those requiring postoperative extracorporeal membrane oxygenation were excluded. Due to the standardized use of treprostinil in our center starting in 2021, patients from 2019–2020 were included in Group 1, and patients from 2021–2022 were included in Group 2. The changes in hemodynamic data before and after medication for both groups of patients, as well as the differences in postoperative recovery, were compared. Results: Twenty-eight patients were eventually enrolled in the study. Group 1 consisted of 14 cases, with a maintenance dose of 11 ± 2 ng/(kg·min) 1 to 2 days postoperatively. Group 2 also consisted of 14 cases, with a maintenance dose of 26 ± 7 ng/(kg·min) 1 day postoperatively. After a 24-h observation period, the mPAP decreased from 17 ± 3 to 13 ± 3 mmHg (p < 0.001) in the first group and decreased from 18 ± 3 to 13 ± 3 mmHg (p < 0.001) in the second group. The vasoactive-inotropic score in the first group decreased from 9 (6,17) to 6 (4,9) (p = 0.001) and decreased from 12 (6,23) to 10 (3,15) (p = 0.002) in the second group. Group 2 patients had a shorter postoperative hospital stay than Group 1, with durations of 18 (11,22) days and 29 (19,47) days, respectively (p = 0.021). No severe adverse reactions occurred in all patients. Conclusion: Intravenous infusion of treprostinil in high-risk patients after the Glenn procedure can decrease pulmonary artery pressure, reduce vasoactive-inotropic score, and demonstrate satisfactory drug tolerance without severe adverse reactions. Standardized use of treprostinil facilitates postoperative recovery and shortens postoperative length of stay.

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Keywords

Single ventricle; pulmonary hypertension; Glenn procedure; treprostinil

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