Bidirectional Glenn and Antegrade Pulmonary Blood Flow: Temporary or Definitive Palliation?

Background We sought to investigate the role of the bidirectional Glenn with antegrade pulmonary blood flow in the surgical history of children with univentricular hearts. Methods A series of 246 patients, from three joint institutions, having univentricular heart with restricted but not critical pu...

Ausführliche Beschreibung

Gespeichert in:
Bibliographische Detailangaben
Veröffentlicht in:The Annals of thoracic surgery 2008-04, Vol.85 (4), p.1389-1396
Hauptverfasser: Calvaruso, Davide F., MD, Rubino, Antonio, MD, Ocello, Salvatore, MD, Salviato, Nicoletta, MD, Guardì, Diego, MD, Petruccelli, David F., MD, Cipriani, Adriano, MD, Fattouch, Khalil, MD, PhD, Agati, Salvatore, MD, Mignosa, Carmelo, MD, Zannini, Lucio, MD, Marcelletti, Carlo F., MD
Format: Artikel
Sprache:eng
Schlagworte:
Online-Zugang:Volltext
Tags: Tag hinzufügen
Keine Tags, Fügen Sie den ersten Tag hinzu!
Beschreibung
Zusammenfassung:Background We sought to investigate the role of the bidirectional Glenn with antegrade pulmonary blood flow in the surgical history of children with univentricular hearts. Methods A series of 246 patients, from three joint institutions, having univentricular heart with restricted but not critical pulmonary blood flow received a bidirectional cavopulmonary shunt with additional forward pulmonary blood flow. All patients have been studied according to their progression, or not, to Fontan operation. Two hundred and eight (84.5%) patients underwent bidirectional cavopulmonary anastomosis as primary palliation. Twenty patients (8.1%) with previous pulmonary artery banding were also enrolled in the study. Patients who had received additional pulmonary blood flow through a previous systemic to pulmonary artery shunt for the critical pulmonary blood flow were excluded. Results No in-hospital death occurred. Follow-up was complete at 100%. Mean follow-up was 4.2 ± 2.8 years (range, 6 months to 7 years). During the observational period 73 (29.7%) patients, considered optimal candidates, underwent Fontan completion for increasing cyanosis and (or) hematocrit and (or) fatigue with exertion. Three patients expired after total cavopulmonary connection (3 of 73; 4.1% mortality rate). The remaining 173 (70.3%) patients are alive with initial palliation. All patients were still well palliated with an arterial oxygen saturation at rest about 90%. Conclusions According to our experience and results, bidirectional Glenn with antegrade pulmonary blood flow may be an excellent temporary palliation prior to a Fontan operation, which can be performed at the onset of symptoms. Bidirectional Glenn may also be the best possible palliation for a suboptimal candidate for Fontan.
ISSN:0003-4975
1552-6259
DOI:10.1016/j.athoracsur.2008.01.013