title: Clinical outcomes of prophylactic Damus-Kaye-Stansel anastomosis concomitant with bidirectional Glenn procedure.
abstract: OBJECTIVE
  We evaluated prophylactic Damus-Kaye-Stansel (DKS) anastomosis in association with the timing of a bidirectional Glenn (BDG) procedure as second-stage palliation aiming at Fontan completion to prevent late systemic ventricular outflow tract obstruction.
  
  
  METHODS
  Between 1996 and 2005, 25 patients (14 boys; median age, 12 months) underwent a BDG procedure concomitant with DKS anastomosis. All had a systemic ventricular outflow tract through an intraventricular communication or morphologically developed subaortic conus and had previously undergone pulmonary artery banding. Enlargement of intraventricular communication and/or resection of a subaortic conus were not performed before or during the operation.
  
  
  RESULTS
  Twenty-one (84%) patients subsequently underwent a Fontan operation, with a follow-up period of 6.8 ± 1.9 years (range, 4-11 years), with no mortalities after the Fontan operation. Cardiac catheterization showed that systemic ventricular end-diastolic volume was significantly decreased from 187% ± 74% of normal before BDG to 139% ± 35% after (P = .038) and to 73% ± 14% at 4.3 years after the Fontan operation (P < .001). However, the pressure gradient across the systemic ventricular outflow tract remained at 0.5 ± 0.8 mm Hg after DKS anastomosis and 0.6 ± 2.3 mm Hg at 4.6 years after the Fontan operation. None of the patients showed more than moderate aortic or neoaortic regurgitation, except 1 who progressed to pulmonary regurgitation after DKS anastomosis and required a reoperation for a systemic ventricular outflow tract. No anatomic properties affected late neoaortic valve function.
  
  
  CONCLUSIONS
  Regardless of a significant reduction in systemic ventricular volume, DKS anastomosis concomitant with a BDG procedure shows promise for a nonobstructive systemic ventricular outflow tract after a Fontan operation.
authors: Department of Pediatric Cardiovascular Surgery, National Cerebral and Cardiovascular Center, Suita, Japan.
authors: Masatoshi
authors: M
authors: Shimada
authors: Takaya
authors: T
authors: Hoashi
authors: Koji
authors: K
authors: Kagisaki
authors: Isao
authors: I
authors: Shiraishi
authors: Toshikatsu
authors: T
authors: Yagihara
authors: Hajime
authors: H
authors: Ichikawa
mesh_terms: D000714:Anastomosis, Surgical; D006348:Cardiac Surgical Procedures / Q000379:methods; D002648:Child; D002675:Child, Preschool; D005260:Female; D018729:Fontan Procedure; D006330:Heart Defects, Congenital / Q000601:surgery*; D006352:Heart Ventricles / Q000002:abnormalities* / Q000601:surgery*; D006801:Humans; D007223:Infant; D008297:Male; D012189:Retrospective Studies; D016896:Treatment Outcome