title: Half a Century's Experience With the Superior Cavopulmonary (Classic Glenn) Shunt.
abstract: BACKGROUND
  Five decades after its introduction, the Glenn shunt remains an integral step for patients undergoing single-ventricle palliation. We performed a longitudinal follow-up of the original cohort of patients who underwent Glenn shunt.
  
  
  METHODS
  We performed a retrospective study of the original cohort of patients who underwent Glenn shunt at Yale between 1958 and 1988. Electronic medical records and chart review up to current era were used to collect data.
  
  
  RESULTS
  Ninety-one patients underwent a Glenn shunt at an average age of 6.6 ± 2.5 years, of which 89 were classic Glenn shunts. Median overall survival was 43 years (range, 2 to 56; 95% confidence interval [CI], 39.5 to 46.5) while median survival from the Glenn shunt was 31.4 years (range, 0 to 45; 95% CI, 23.9 to 38.9). Forty-six patients died, 7 in the early postoperative period and 39 late deaths. Twenty-six patients were lost to follow-up. Nineteen patients remain alive with active clinical follow-up, 6 of whom still live with their classic Glenn shunt without conversion to bidirectional Glenn. Twenty-six patients (31%) developed pulmonary arteriovenous fistula with 11 patients (42%) requiring coil embolization. No patient developed thrombosis of the Glenn shunt. There were a total of 28 patients who developed arrhythmias, mostly in the tricuspid atresia group (n = 16), with the majority being atrial tachyarrhythmias (48%). Sixteen patients required permanent pacemaker placement for sinus node dysfunction.
  
  
  CONCLUSIONS
  The Glenn shunt continues to provide excellent staged palliation in single-ventricle patients and a bridge to two-ventricle repair. Arrhythmias and pulmonary arteriovenous fistulas were common among single-ventricle cohort. Quality-of-life evaluation of the surviving patients would be an important outcome measure for future investigation.
authors.affiliation: Department of Pediatrics, Section of Pediatric Cardiology, Yale University School of Medicine, New Haven, Connecticut.
authors.forename: Riad Abou
authors.initials: RA
authors.lastname: Zahr
authors.affiliation: Department of Surgery, Section of Pediatric Cardiothoracic Surgery, Yale University School of Medicine, New Haven, Connecticut.
authors.forename: Paul M
authors.initials: PM
authors.lastname: Kirshbom
authors.affiliation: Department of Surgery, Section of Pediatric Cardiothoracic Surgery, Yale University School of Medicine, New Haven, Connecticut.
authors.forename: Gary S
authors.initials: GS
authors.lastname: Kopf
authors.affiliation: Department of Surgery, Section of Pediatric Cardiothoracic Surgery, Yale University School of Medicine, New Haven, Connecticut.
authors.forename: Sandeep
authors.initials: S
authors.lastname: Sainathan
authors.affiliation: Department of Surgery, Section of Pediatric Cardiothoracic Surgery, Yale University School of Medicine, New Haven, Connecticut.
authors.forename: Margaret M
authors.initials: MM
authors.lastname: Steele
authors.affiliation: Department of Pediatrics, Section of Pediatric Cardiology, Yale University School of Medicine, New Haven, Connecticut.
authors.forename: Robert W
authors.initials: RW
authors.lastname: Elder
authors.affiliation: Department of Surgery, Section of Pediatric Cardiothoracic Surgery, Yale University School of Medicine, New Haven, Connecticut. Electronic address: mohsen.karimi@yale.edu.
authors.forename: Mohsen
authors.initials: M
authors.lastname: Karimi
mesh_terms: D002648:Child; D005260:Female; D005500:Follow-Up Studies; D018729:Fontan Procedure / Q000379:methods*; D005544:Forecasting; D006330:Heart Defects, Congenital / Q000601:surgery*; D006352:Heart Ventricles / Q000002:abnormalities / Q000601:surgery*; D006801:Humans; D008297:Male; D010166:Palliative Care / Q000379:methods; D011651:Pulmonary Artery / Q000601:surgery*; D012189:Retrospective Studies; D016896:Treatment Outcome