title: [Risk factors in the Glenn bidirectional shunt as an intermediate procedure before Fontan correction].
abstract: OBJECTIVE
  The bidirectional Glenn shunt is the most common palliation before the Fontan repair, especially in high-risk patients. We studied the influence of certain risk factors in bidirectional Glenn results, with and without an additional source of pulmonary blood flow.
  
  
  METHODS
  Between 1993 and 1998 twenty patients (6-53 months of age) underwent a bidirectional Glenn shunt as the intermediate repair for the Fontan procedure. Diagnoses were: 7 cases of double inlet single ventricle, 4 of tricuspid atresia, 3 of unbalanced AV septal defect, 4 of mitral atresia, 1 hypoplastic left heart syndrome and 1 TGA with hypoplasia of the right ventricle. 17 patients had undergone previous operations. Mean preoperative arterial oxygen saturation was 78.5%. In 6 patients an auxiliary source of pulmonary blood flow was added.
  
  
  RESULTS
  Hospital mortality was 15%. In 4 patients the bidirectional Glenn failed. By univariate analysis low weight, preoperative functional status and high pulmonary pressure were factors associated with early death. In bidirectional Glenn failure only the duration of ventilatory support was significant. By multivariate analysis, preoperative functional status and pulmonary pressure were significant. Mean postoperative arterial oxygen saturation at a mean follow-up of 10 months was 84%.
  
  
  CONCLUSIONS
  Bidirectional Glenn shunt is an effective and low-risk palliation for patients with univentricular hearts. Only low weight and high pulmonary pressure were significant in hospital mortality, and we advise the association of an additional source of pulmonary blood flow in these patients at the start. Early extubation provides correct performance of the shunt.
authors.affiliation: Sección de Cirugía Cardíaca Pediátrica, Hospital Infantil La Fe, Valencia, España.
authors.forename: F J
authors.initials: FJ
authors.lastname: Valera Martínez
authors.forename: J
authors.initials: J
authors.lastname: Caffarena Calvar
authors.forename: J M
authors.initials: JM
authors.lastname: Gómez-Ullate
authors.forename: J
authors.initials: J
authors.lastname: Gómez-Plana Usero
authors.forename: J I
authors.initials: JI
authors.lastname: Carrasco
authors.forename: J M
authors.initials: JM
authors.lastname: Sáez
authors.forename: P
authors.initials: P
authors.lastname: Malo Concepción
authors.forename: J M
authors.initials: JM
authors.lastname: Caffarena Raggio
mesh_terms: D000714:Anastomosis, Surgical / Q000379:methods / Q000706:statistics & numerical data; D002675:Child, Preschool; D005260:Female; D018729:Fontan Procedure; D006330:Heart Defects, Congenital / Q000601:surgery; D006801:Humans; D007223:Infant; D008297:Male; D015999:Multivariate Analysis; D010166:Palliative Care / Q000379:methods* / Q000706:statistics & numerical data; D011651:Pulmonary Artery / Q000601:surgery*; D012307:Risk Factors; D014683:Vena Cava, Superior / Q000601:surgery*