Treprostinil >15.5 ng/kg·min reduced adverse outcomes (OR 0.871), with greater mPAP reduction in Glenn patients who had higher resuscitation (29% vs 6%) and mortality (11% vs 0%).
Does intravenous Treprostinil improve hemodynamics and postoperative outcomes differently in pediatric patients following Glenn versus Fontan procedures?
Intravenous Treprostinil effectively reduces pulmonary artery pressure in pediatric single-ventricle patients post-palliation, with greater hemodynamic efficacy in Glenn patients, and doses >15.5 ng/kg/min may protect against adverse postoperative outcomes.
Absolute Event Rate: 0% vs 0%
To compare the hemodynamic effects of Treprostinil and postoperative outcomes in pediatric single-ventricle patients with pulmonary hypertension (PH, mean pulmonary artery pressure (mPAP) > 15 mmHg) following Glenn or Fontan palliation, and identify key prognostic factors associated with treatment response and clinical outcomes. Retrospective analysis of 79 pediatric patients (28 Glenn in Group 1 and 51 Fontan in Group 2) from 2015 to 2022, excluding those requiring postoperative extracorporeal membrane oxygenation. All received intravenous Treprostinil. Changes in mPAP, vasoactive-inotropic score, and postoperative recovery parameters were compared. Binary logistic regression identified prognostic factors, and receiver operating characteristic curve analysis evaluated Treprostinil dose predictive value. Regimen distribution did not differ between groups (14 vs. 14 in Group 1 and 35 vs. 16 in Group 2 on early/later standardized regimens, P = 0.103). Group 1 had more additional cardiac procedures (75% vs. 49%, P = 0.025), with similar Treprostinil maintenance doses (17.5 10,25 vs. 15 14,20 ng/(kg·min), P = 0.421). At 24 h, mPAP decreased significantly more in Group 1 (17 ± 3 to 13 ± 3 mmHg vs. 17 ± 3 to 15 ± 2 mmHg, P 15.5 ng/(kg·min) (area under the curve = 0.717) protected against adverse outcomes (thromboembolic events, renal replacement therapy, tracheal reintubation, mortality, resuscitation). Treprostinil effectively reduces mPAP in both groups, with significantly greater hemodynamic efficacy in Glenn patients, who face higher resuscitation and mortality risks due to greater anatomical complexity. Fontan patients have lower mortality but prolonged morbidity from pleural effusions. The Treprostinil maintenance dose > 15.5 ng/(kg·min) is a protective factor for postoperative adverse outcomes.
Wang et al. (Sun,) reported a other. Treprostinil >15.5 ng/kg·min reduced adverse outcomes (OR 0.871), with greater mPAP reduction in Glenn patients who had higher resuscitation (29% vs 6%) and mortality (11% vs 0%).