One and a half ventricle repair with pulsatile bidirectional Glenn: results and guidelines for patient selection.
BACKGROUND
The guidelines for performing a one and a half ventricle repair with pulsatile bidirectional Glenn remains controversial. This retrospective report summarizes the experience of a single institution, with an attempt at providing an answer.


METHODS
Fifty consecutive patients, aged 4 months to 42 years, underwent intracardiac repair along with a superior cavopulmonary connection. Twenty-seven of the patients had had previous surgical palliation. Repair consisted of patch closure of the ventricular septal defect (n = 25), tricuspid valve repair (n = 26), reconstruction of the right ventricular outflow tract (n = 34), transpulmonary annular patch (n = 34), right ventricle to pulmonary artery homograft conduit (n = 4), and concomitant repair of atrioventricular canal (n = 9). Ten patients were left with a fenestration in the atrial septum.


RESULTS
There were six hospital deaths (12%) and two late deaths (4.5%). Forty-two survivors were followed from 8 months to 116 months. Eighty-eight percent are in functional class I. Actuarial survival at 97 months was 74%.


CONCLUSIONS
Moderate right heart hypoplasia constitutes a safe anatomic category for a pulsatile bidirectional Glenn. It is advisable not to proceed with a one and a half ventricle repair if postoperative residual pulmonary artery hypertension is anticipated. Patients requiring an intricate intracardiac repair and those with concomitant right heart hypoplasia may be better suited for a Fontan type of repair to reduce the complexity of the procedure.
Chowdhury
U K
UK
Department of Cardiothoracic and Vascular Surgery, All India Institute of Medical Sciences, Ansari Nagar, New Delhi.
Airan
B
B
Sharma
R
R
Bhan
A
A
Kothari
S S
SS
Saxena
A
A
Venugopal
P
P
D000206:Actuarial Analysis; D000293:Adolescent; D000328:Adult; D002648:Child; D002675:Child, Preschool; D005260:Female; D005500:Follow-Up Studies; D018610:Heart Bypass, Right; D006330:Heart Defects, Congenital / Q000401:mortality / Q000601:surgery*; D006352:Heart Ventricles / Q000002:abnormalities* / Q000601:surgery; D017052:Hospital Mortality; D006801:Humans; D007223:Infant; D008297:Male; D018579:Patient Selection; D011183:Postoperative Complications / Q000401:mortality; D017410:Practice Guidelines as Topic; D011379:Prognosis; D012086:Reoperation; D015996:Survival Rate; D018785:Tricuspid Atresia / Q000401:mortality / Q000601:surgery