Need for Pulmonary Arterioplasty During Glenn Independently Predicts Inferior Surgical Outcome

Commentary: There are no facts, only interpretations

“…Surgeons have different philosophies about this controversial practice. [3][4][5] Unfortunately, the current study does not offer any help in addressing this controversy. It remains unknown whether the PAB was placed as part of routine surgeon preference or because of anatomic factors (eg, hypoplastic pulmonary arteries, small bilateral superior vena cava) or hemodynamic reasons (ie, higher-risk patients).…”

“…6 On the other hand, it could be that PAB with CPS is associated with increased complications and directly associated with worse outcomes, and it also could be that PAB is a proxy for morphology (obviously, patients with pulmonary atresia or severe stenosis will not get a PAB). 4,5,7 In short, it is inevitable that some single ventricle patients will fail to qualify or progress in the multistage palliation strategy. Timely identification of these patients to direct them toward heart transplantation is the only valid alternative that can improve survival.…”

The Superior Cavopulmonary Connection: History and Current Perspectives

“…A growing list of risk factors for complications, lengths of stay, and transplant-free and overall survival after second-stage palliation has accumulated over the past decade (Table 1). [42][43][44][45][46][47][48][49][50][51] This list includes many patient factors as well as factors related to either stage I or II procedure and management. While it is difficult to systematically compare the weight of each factor, those most commonly cited from these studies include atrioventricular valve regurgitation (>mild), ventricular dysfunction, need for reintervention, and failure to attain nutritional and/or growth goals.…”

Management for bidirectional cavopulmonary shunt failure: Adding aortopulmonary shunt without takedown

“…Many studies have shown that this approach has a high mortality rate. [1][2][3] We would like to mention an alternative treatment for BCPS failure without BCPS takedown.…”

“…I discussed in my first Commentary that the necessity of an unrestricted passive systemic blood flow to the pulmonary artery is of paramount importance for the optimal function of a Fontan circulation. 1,2 As additional information, T€ urk€ oz and Dogan 3 report on 2 cases in which an additional aorto-toleft pulmonary artery shunt with a banding performed between the Glenn anastomosis and the shunt to pulmonary artery anastomosis helped to manage a situation of a failing bidirectional cavopulmonary shunt. This shunt, with a minimal pulsatility, helped to increase the "vis a tergo" (a power from behind) that I had postulated as important feature for the success of a Glenn shunt.…”