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 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.
Calvaruso
Davide F
DF
Department of Pediatric Cardiac Surgery Marta e Milagros, Azienda di Rilievo Nazionale e di Alta Specializzazione, Ospedale Civico, Palermo, Italy. davidecalvaruso@hotmail.com
Rubino
Antonio
A
Ocello
Salvatore
S
Salviato
Nicoletta
N
Guardì
Diego
D
Petruccelli
David F
DF
Cipriani
Adriano
A
Fattouch
Khalil
K
Agati
Salvatore
S
Mignosa
Carmelo
C
Zannini
Lucio
L
Marcelletti
Carlo F
CF
D000293:Adolescent; D000328:Adult; D001166:Arteriovenous Shunt, Surgical / Q000379:methods* / Q000401:mortality; D002648:Child; D002675:Child, Preschool; D015331:Cohort Studies; D005260:Female; D005500:Follow-Up Studies; D018729:Fontan Procedure / Q000379:methods; D018610:Heart Bypass, Right / Q000379:methods*; D006330:Heart Defects, Congenital / Q000175:diagnosis / Q000401:mortality / Q000601:surgery*; D006352:Heart Ventricles / Q000002:abnormalities*; D006801:Humans; D007223:Infant; D053208:Kaplan-Meier Estimate; D016014:Linear Models; D008297:Male; D010166:Palliative Care / Q000379:methods*; D011652:Pulmonary Circulation / Q000502:physiology*; D012189:Retrospective Studies; D018570:Risk Assessment; D012680:Sensitivity and Specificity; D015996:Survival Rate; D016896:Treatment Outcome