Factors Influencing Survival in Patients after Bidirectional Glenn Shunt

Abstract

Clinical characteristics, echocardiographic values, and catheterization data of 45 patients with a functional univentricular heart who had a bidirectional Glenn shunt instituted between November 1994 and October 2006 were retrospectively reviewed. Median age at operation was 20 months (range, 9 months to 19 years). Median follow-up time after the bidirectional Glenn operation was 4 years (range, 1 day to 11 years). The early mortality rate was 4/45 (8.9%); overall mortality was 24.4%. Actuarial survival after a bidirectional Glenn shunt was 73% +/- 8% at 5 years and 55% +/- 17% at 10 years. In multivariate Cox proportional hazards analysis, heterotaxy syndrome and systemic right ventricle were independent predictors of mortality after the bidirectional Glenn shunt. Age at operation, oxygen saturation, previous surgery, a pulsatile Glenn shunt, cardiopulmonary bypass, postoperative pulmonary artery pressure, bilateral superior venae cavae, and Nakata index were not predictive of mortality. The presence of heterotaxy syndrome and systemic right ventricle in patients with a functional univentricular heart should lead to aggressive investigation and management strategies.

Results of Additional Pulsatile Pulmonary Blood Flow with Bidirectional Glenn Cavopulmonary Anastomosis: Positive Effect on Main Pulmonary Artery Growth and Less Need for Fontan Conversion

“…BDG cavopulmonary anastomosis has several advantages, including relief of the volume load on a single functional ventricle [Kobayashi 1991;McElhinney 1998], reduced atrioventricular valve regurgitation, avoidance of PA distortion resulting from PA banding or a systemic-to-pulmonary artery shunt, reduction of ventricle size, and prevention of pulmonary vascular obstructive disease [Silvilairat 2008]. In 1991, Kobayashi et al first reported the use of BDG with an additional pulmonary blood flow in children not suitable for the Fontan procedure, which is the standard definitive palliation in such patients [Kobayashi 1991].…”

“…A number of disagreements exist regarding BDG, including timing of the procedure [Silvilairat 2008] and the interval to Fontan completion. Moreover, there is contention regarding the use or elimination of accessory pulsatile forward pulmonary blood flow [Silvilairat 2008].…”

“…Proponents for the provision of APBF cite many advantages and refer to more physiological levels of oxygen saturation, inhibition of pulmonary arteriovenous malformations, and the potential to decrease development of PA collateral vessel development [Silvilairat 2008]. Kobayashi et al also reported APBF benefit in preventing the development of pulmonary arteriovenous malformations because of the delivery of hepatic venous blood to the pulmonary capillaries [Kobayashi 1991].…”

Impacts of Isomerism (Heterotaxy) on Birth Hospitalization

“…Many patients with isomerism will require cardiac surgery, some requiring staged surgery as they proceed along the functionally univentricular pathway. Isomerism has been noted to impact postoperative outcomes and general morbidity and mortality [9][10][11]. What has not been previously described are the characteristics of the initial birth hospitalization in those with isomerism compared to those without.…”

Need for Pulmonary Arterioplasty During Glenn Independently Predicts Inferior Surgical Outcome

“…Concomitant procedures are often required at the time of BDCA to ensure optimal anatomic and physiologic conditions for completion Fontan. Prior publications have evaluated risk factors for second-stage mortality and morbidity [4,[7][8][9][10][11][12][13]. No study to date has primarily focused on the impact of pulmonary arterioplasty (PAplasty) on BDCA outcomes [4,7].…”