Usefulness of the bidirectional Glenn procedure as staged reconstruction for the functional single ventricle

Pridjian, Ara K.; Mendelsohn, Alan M.; Lupinetti, Flavian M.; Beekman, Robert H.; Dick, Macdonald; Serwer, Gerald A.; Bove, Edward L.

doi:10.1016/0002-9149(93)90914-x

Cited by 157 publications

(87 citation statements)

References 10 publications

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“…Nevertheless, this possible disadvantage of BCPS does not compromise Fontan candidacy, because some reports have documented the pulmonary artery index as a non predictor of operative survival. In contrast, extended pulmonary artery reconstruction concomitantly performed with BCPS resulted in significant improvement in the pulmonary variables including PAP, Rp and PAI, in addition to successful relief of this important anatomical risk, as reported by Pridjian et al 2 Our results documented that the number of risk factor was significantly decreased after BCPS and this may imply a possible role for the two-stage approach to contribute to improving Fontan candidacy. When progressed ventricular dysfunction or atrioventricular valve regurgitation exists as a result of prior ventricular overload or when there is pulmonary hypertension without irreversible pulmonary vascular disease, BCPS may improve the Fontan candidacy during a waiting interim period prior to the completion of Fontan.…”

Section: Discussionsupporting

confidence: 78%

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The role of a staged approach for high-risk Fontan candidates

Morita

Kurosawa

Mizuno

et al. 1999

Jpn J Thorac Caridovasc Surg

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The preoperative risk characteristics and surgical outcome were reviewed in 24 patients who underwent a one-stage Fontan procedure (One-stage Group) and in 16 patients who underwent bidirectional cavopulmonary shunt as an interim procedure prior to a subsequent Fontan procedure (Two-stage Group) to clarify the role of the staged approach for high-risk Fontan candidates. There were 2 hospital deaths after the one-stage Fontan, and another 2 after the takedown of the fenestrated Fontan to BCPS in patients considered to be less than ideal candidate because of the presence of 3 or more risk factors. In contrast, among the total of 16 patients in the Two-stage Group who had significantly more risk factors than those in One-stage Group (2.8 +/- 1.4, vs 1.1 +/- 1.2 p < 0.001), 14 patients survived after bidirectional cavopulmonary shunt, and a subsequent Fontan procedure was accomplished in 12 patients of these 14, with 2 operative deaths after the takedown to bidirectional cavopulmonary shunt. The rate of final Fontan completion in the Two-stage Group (10/16, 62.5%) was considered to be reasonable, considering the fact that this patient group essentially includes non-Fontan candidates. Additionally, in the category of high-risk with 3 or more risk factors, the rate of successful Fontan completion was higher in the Two-stage Group than in the One-stage Group (50% vs 25%). In the survivors of the Two-stage Group, the average number of risk factor decreased from 2.7 +/- 1.3 (range 0 to 5) to 1.0 +/- 1.0 (range 0 to 4) after bidirectional cavopulmonary shunt with concomitant procedures (i.e., extended pulmonary artery reconstruction in 8, and repair of atrioventricular valve regurgitation in 4), predominantly due to improved Fontan candidacy, relating to pulmonary and/or ventricular characteristics, and eliminated anatomical risks. In conclusion, the two-stage approach with bidirectional cavopulmonary shunt accompanied by concomitant repair of associated anomaly may be useful to lower the risk enough to allow subsequent Fontan completion in high-risk patients.

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Section: Discussionsupporting

confidence: 78%

“…[2][3][4] However, less information is available in the literature to confirm the role of a staged surgical strategy on improving Fontan candidacy and cumulative mortality. Furthermore, the definitive criteria for patient selection for a two-stage approach has yet to be determined.…”

mentioning

confidence: 99%

The role of a staged approach for high-risk Fontan candidates

Morita

Kurosawa

Mizuno

et al. 1999

Jpn J Thorac Caridovasc Surg

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“…The reduced volume load that is achieved with the bidirectional Glenn procedure improves diastolic function and reduces the ventricular wall thickness at the time of the Fontan procedure. 3 …”

Section: Brief Review Of Stages I and Iimentioning

confidence: 99%

The Fontan Procedure for Single-Ventricle Physiology

Jones

2018

Critical Care Nurse

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The Fontan procedure is the final procedure in staged palliation for patients with functional single-ventricle physiology. The goal of the procedure is to separate systemic and pulmonary blood flow by directing systemic venous return through the Fontan connection to the pulmonary arteries and the lungs without ventricular contribution. Following the procedure, pulmonary blood flow is completely passive and dependent on pressure gradients, resulting in complex postoperative cardiopulmonary interactions. Understanding the physiology is essential to effectively manage these patients. Critical care nurses caring for patients after a Fontan procedure must understand preoperative data, risk factors, and unique postoperative physiology so they can anticipate specific postoperative problems, recognize trends in clinical status, and develop an appropriate plan of care. This paper reviews the first 2 stages of single-ventricle palliation, relevant modifications to the Fontan procedure, important preoperative cardiac catheterization data, common postoperative problems, and outcomes after the Fontan procedure. 1 The goal of the Fontan procedure is to completely separate pulmonary and systemic blood flow, thereby preventing the mixing of oxygenated and deoxygenated blood.2 Systemic venous return is passively diverted through the Fontan circuit directly to the pulmonary arteries and the lungs without any ventricular contribution to flow. Since its inception, the surgical procedure has undergone many modifications to optimize the hemodynamics and minimize the risks. As with the surgical modifications, postoperative management has evolved as our understanding of the complex cardiopulmonary interactions has improved. This article has been designated for CE contact hour(s). The evaluation tests your knowledge of the following objectives: 1. Articulate the purpose of the Fontan operation. 2. Describe the major modifications to the Fontan operation. 3. Explain common postoperative problems after the Fontan operation.To complete evaluation for CE contact hour(s) for activity C1813, visit www.ccnonline.org and click the "CE Articles" button. No CE fee for AACN members. This activity expires on February 1, 2021.

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“…When this is not possible due to the emergency nature of the surgery, the MPAP can be measured in the intraoperative period, as was done with two patients in our study. A MPAP of more than 17 mmHg or for under 4-month-old children more than 21 mmHg [8] is considered a higher risk [9] as the presence of an anterograde pulmonary flow can cause higher pressures. In our series the median pressure was 13 mmHg, an adequate level which was not considered to be associated to risk of mortality.…”

Section: Commentsmentioning

confidence: 99%

A operação de Glenn bidirecional deve ser realizada com ou sem o auxílio de circulação extracorpórea?

Crotti¹,

Braile²,

Godoy³

et al. 2004

Rev Bras Cir Cardiovasc

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Objective: To compare patients who underwent the Bidirectional Glenn Operation with and without cardiopulmonary bypass (CPB), analyzing the characteristics and confirming if there is superiority of either of the employed techniques.Method: Between January 2002 and January 2004, 16 patients with complex heart defects were submitted to this operative technique. The mean age of the patients was 19 months and 14 were female. The patients were divided into two groups: Group A with 7 patients (using CPB) and group B with 9 patients (without the use of CPB). Gender, age, mean pulmonary artery pressure (MPAP), CPB time, aortic clamping time, venoatrial shunt, previous operations, time in intensive care unit (ICU), total hospitalization time and immediate complications were all compared between the two groups.Results: The median MPAP was 13 mmHg. In group A the CPB time was 91 ± 47 minutes (57-195 minutes), myocardial ischemia was 25 ± 33 minutes (0-80 minutes). Of these, four patients required intracardiac procedures or enlargement of the pulmonary branches and in three, CPB assistance as ventilatory support was needed. In group B the venoatrial shunt was 21 ± 10 minutes (0-39 minutes). The time to extubation was 9 ± 13 hours with a median of 3 hours (1-43 hours). The ICU stay was 8 ± 12 days with a median of 5 days (1-50 days). Hospitalization was 12 ± 12 days with a median of 7 days (0-50 days). Five patients had been submitted to surgeries previously. Two, one patient from each group, died (12.5%). No neurological complications, pleural or pericardial effusions were observed. No significant differences were evidenced between the two groups in respect to all the variables studied.Conclusion: In spite of the relatively small cohort, this study suggests that the bidirectional Glenn operation can be performed with or without CPB giving similar results in respect to morbidity and mortality. Thus, the operation without CPB can be safely employed when the anatomic findings are appropriate and there is no severe hypoxia.

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Usefulness of the bidirectional Glenn procedure as staged reconstruction for the functional single ventricle

Cited by 157 publications

References 10 publications

The role of a staged approach for high-risk Fontan candidates

The role of a staged approach for high-risk Fontan candidates

The Fontan Procedure for Single-Ventricle Physiology

A operação de Glenn bidirecional deve ser realizada com ou sem o auxílio de circulação extracorpórea?

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