title: Impact of bilateral superior venae cavae on outcome of staged Fontan procedure.
abstract: BACKGROUND
  The presence of bilateral superior venae cavae may add complexity to the performance of a bidirectional Glenn procedure (BDG). Stagnation of blood flow between the two cavopulmonary anastomoses may increase the risk of thrombosis and impair central pulmonary artery growth.
  
  
  METHODS
  Forty patients underwent BDG from January 2004 to April 2011. The cohort was divided into two groups: those receiving bilateral BDG (b-BDG, n = 13) and those receiving unilateral BDG (u-BDG, n = 27). Operative, angiographic, and follow-up data were analyzed retrospectively.
  
  
  RESULTS
  None of the patients experienced thrombosis. There was no difference in actuarial survival rate (u-BDG vs b-BDG, 100% vs 92% at 5 years, p = 0.15). On follow-up angiography, no difference in central pulmonary artery index was noted (78.4 ± 45.5 vs 60.4 ± 32.1, p = 0.24). Central pulmonary artery stenosis was detected in 6 patients (4 with u-BDG and 2 with b-BDG), 4 of whom (2 from each group) underwent balloon pulmonary artery plasty before the Fontan procedure. There was no difference in freedom from reintervention for central pulmonary artery stenosis (93% vs 85% at 1 year, p = 0.59). The rate of Fontan completion was comparable between groups, with similar operative variables and satisfactory outcomes.
  
  
  CONCLUSIONS
  Bilateral BDG did not increase the risks of thrombosis and central pulmonary artery hypoplasia and can be performed safely without altering the outcome of the Fontan procedure.
authors.affiliation: Department of Pediatric Cardiac Surgery, Kumamoto City Hospital, Kumamoto, Japan. Electronic address: yuandou-circ@umin.ac.jp.
authors.forename: Yusuke
authors.initials: Y
authors.lastname: Ando
authors.affiliation: Department of Pediatric Cardiac Surgery, Kumamoto City Hospital, Kumamoto, Japan.
authors.forename: Koji
authors.initials: K
authors.lastname: Fukae
authors.affiliation: Department of Pediatric Cardiac Surgery, Kumamoto City Hospital, Kumamoto, Japan.
authors.forename: Kazuto
authors.initials: K
authors.lastname: Hirayama
authors.affiliation: Department of Cardiovascular Surgery, Kumamoto City Hospital, Kumamoto, Japan.
authors.forename: Masahiro
authors.initials: M
authors.lastname: Oe
authors.affiliation: Department of Cardiovascular Surgery, Kumamoto City Hospital, Kumamoto, Japan.
authors.forename: Toshiro
authors.initials: T
authors.lastname: Iwai
mesh_terms: D000293:Adolescent; D000714:Anastomosis, Surgical / Q000379:methods; D002648:Child; D005260:Female; D005500:Follow-Up Studies; D018729:Fontan Procedure / Q000379:methods*; D006330:Heart Defects, Congenital / Q000601:surgery*; D006801:Humans; D008297:Male; D011651:Pulmonary Artery / Q000601:surgery*; D012189:Retrospective Studies; D013997:Time Factors; D016896:Treatment Outcome; D014683:Vena Cava, Superior / Q000601:surgery*