[Risk factors in the Glenn bidirectional shunt as an intermediate procedure before Fontan correction]

Area of Science:

• Pediatric Cardiology
• Congenital Heart Surgery
• Hemodynamics

Background:

• The bidirectional Glenn shunt is a common palliative procedure for complex congenital heart disease, serving as an intermediate step before the Fontan repair.
• It is particularly utilized in high-risk pediatric patients requiring staged palliation.
• Understanding risk factors influencing outcomes is crucial for optimizing surgical results.

Purpose of the Study:

• To evaluate the effectiveness of the bidirectional Glenn shunt as a palliative procedure.
• To identify specific risk factors impacting the success of the bidirectional Glenn shunt.
• To assess the influence of an additional pulmonary blood flow source on outcomes.

Main Methods:

• A retrospective study of 20 patients (6-53 months) undergoing bidirectional Glenn shunt between 1993-1998.
• Patients had various single ventricle diagnoses, with 17 having prior surgeries.
• Six patients received an auxiliary source of pulmonary blood flow.

Main Results:

• Hospital mortality was 15%, with 4 shunt failures.
• Univariate analysis identified low weight, poor preoperative functional status, and high pulmonary pressure as significant risk factors for early death.
• Multivariate analysis confirmed preoperative functional status and pulmonary pressure as significant predictors of mortality. Postoperative oxygen saturation averaged 84% at 10-month follow-up.

Conclusions:

• The bidirectional Glenn shunt is an effective, low-risk palliative option for patients with univentricular hearts.
• Low weight and elevated pulmonary pressure are significant predictors of in-hospital mortality.
• An additional pulmonary blood flow source is recommended for high-risk patients, and early extubation is advised for optimal shunt performance.