Is additional pulsatile pulmonary blood flow beneficial to patients with bidirectional Glenn?

Ferns, Sunita J.; Zein, Chawki El; Multani, Kanwar; Sajan, Imran; Subramanian, Sujata; Polimenakos, Anastasios C.; Ilbawi, Michel N.

doi:10.1016/j.jtcvs.2012.11.027

Cited by 42 publications

(51 citation statements)

References 15 publications

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“…On the other hand, however, BCPS with APF has potential benefits. The APF may provide additional blood flow into the PA resulting in higher oxygen saturation [12], better growth of PA branches [2,13,14], and may prevent arteriovenous malformation by allowing hepatic blood flow into the PA [5,15]. McElhinney and colleagues [3] published a retrospective study of 160 patients who underwent BCPS between 1990 and 1997, including 93 patients with additional PA flow either through the pulmonary valve or through the systemic-to-pulmonary shunt.…”

Section: Commentmentioning

confidence: 99%

Forward Flow Through the Pulmonary Valve After Bidirectional Cavopulmonary Shunt Benefits Patients at Fontan Operation

Sughimoto

Zannino

Mathew

et al. 2015

The Annals of Thoracic Surgery

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Section: Commentmentioning

confidence: 99%

Forward Flow Through the Pulmonary Valve After Bidirectional Cavopulmonary Shunt Benefits Patients at Fontan Operation

Sughimoto

Zannino

Mathew

et al. 2015

The Annals of Thoracic Surgery

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“…Following birth, pulmonary vascular development continues for several years [2,15,18]; however, a palliated univentricle does not produce pulsatile pulmonary blood flow, possibly further affecting pulmonary vascularity after birth. Studies, reporting the benefit of pulsatile blood sources in patients with Glenn shunts, tend to support these speculations [4,5,7].…”

Section: Discussionmentioning

confidence: 97%

Fontan Hepatic Fibrosis and Pulmonary Vascular Development

Evans

Acherman

Winn³

et al. 2014

Pediatr Cardiol

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Fontan patients are at risk for hepatic fibrosis; however, risk factors are unclear. We performed a multivariate analysis in a small cohort of 14 patients (7-24 years old, mean 15) with Fontan circulation, undergoing cardiac catheterization and transvenous liver biopsies, all demonstrating fibrosis. We found by stepwise regression analysis that the history of pulmonary atresia was a predictor of higher total hepatic fibrosis scores than a history of unobstructed pulmonary blood flow (p = 0.002). Other variables including age, time from Fontan, hemodynamic measurements, and laboratory values were not predictive of total fibrosis scores at p values <0.05. Hepatic fibrosis scores between those born with pulmonary atresia versus unrestricted pulmonary blood flow may reflect differences in pulmonary circulatory physiology, resulting from differences in pulmonary vascular development.

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“…However, BDG has been associated to secondary effects such as pulmonary arteriovenous malformations due to lack of hepatic blood flow into the lungs, decrease in pulmonary artery (PA) growth, and development of aortopulmonary collaterals . Reported advantages of maintaining an additional source of pulmonary blood flow (APBF) include increased PA size, protection of the pulmonary vascular bed, and delaying the Fontan procedure . When APBF is achieved through a patent right ventricular outflow tract, a potential advantage of this “pulsatile Glenn” (PG) include the decrease in development of pulmonary arteriovenous malformations by allowing prograde delivery of hepatic blood flow into the lungs …”

Section: Introductionmentioning

confidence: 99%

Pulsatile Glenn as long-term palliation for single ventricle physiology patients

Chacón-Portillo

Zhu

Dickerson

et al. 2018

Congenital Heart Disease

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Objective There are limited studies analyzing pulsatile Glenn as a long‐term palliation strategy for single ventricle patients. This study sought to determine their outcomes at a single institution. Design A retrospective review was performed. Setting Study performed at a single pediatric hospital. Patients All single ventricle patients who underwent pulsatile Glenn from 1995 to 2016 were included. Outcome measures Pulsatile Glenn failure was defined as takedown, transplant, or death. Further palliation was defined as Fontan, 1.5, or biventricular repair. Risk factors were assessed by Cox multivariable competing risk analyses. Results Seventy‐eight patients underwent pulsatile Glenn at age 9 months (interquartile range, 5‐14). In total, 28% had heterotaxy, 18% had a genetic syndrome, and 24% had an abnormal inferior vena cava. There were 3 (4%) perioperative mortalities. Further palliation was performed in 41 (53%) patients with a median time‐to‐palliation of 4 years (interquartile range, 3‐5). Pulsatile Glenn failure occurred in 10 (13%) patients with 8 total mortalities. Five‐ and 10‐year transplant‐free survival were 91% and 84%, respectively. At a median follow‐up of 6 years (interquartile range, 2‐8), 27 patients (35%) remained with PG (age 7 years [interquartile range, 3‐11], oxygen saturation 83% ± 4%). Preoperative moderate‐severe atrioventricular valve regurgitation (AVVR) (hazard ratio 7.77; 95% confidence interval 1.80‐33.43; P =.005) and higher pulmonary vascular resistance (hazard ratio 2.59; 95% confidence interval 1.08‐6.15; P =.031) were predictors of pulsatile Glenn failure after adjusting for covariates. Reaching further palliation was less likely in patients with preoperative moderate‐severe AVVR (hazard ratio 0.22, 95% confidence interval 0.08‐0.59; P =.002). Conclusion Pulsatile Glenn can be an effective tool to be used in challenging circumstances, these patients can have a favorable long‐term prognosis without reducing their suitability for further palliation.

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Is additional pulsatile pulmonary blood flow beneficial to patients with bidirectional Glenn?

Abstract: Pulsatile bidirectional Glenn is associated with better pulmonary artery growth, which might improve long-term outcomes after Fontan. However, it was associated with a higher postoperative complication rate.

Cited by 42 publications

References 15 publications

Forward Flow Through the Pulmonary Valve After Bidirectional Cavopulmonary Shunt Benefits Patients at Fontan Operation

Forward Flow Through the Pulmonary Valve After Bidirectional Cavopulmonary Shunt Benefits Patients at Fontan Operation

Fontan Hepatic Fibrosis and Pulmonary Vascular Development

Pulsatile Glenn as long-term palliation for single ventricle physiology patients

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