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[Risk factors in the Glenn bidirectional shunt as an intermediate procedure before Fontan correction]
F J Valera Martínez1, J Caffarena Calvar, J M Gómez-Ullate
1Sección de Cirugía Cardíaca Pediátrica, Hospital Infantil La Fe, Valencia, España.
Insights
The bidirectional Glenn shunt is an effective palliation for single ventricle heart defects. Low weight and high pulmonary pressure are key risk factors for mortality, with early extubation and added pulmonary blood flow recommended for high-risk cases.
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.
Objective:
The bidirectional Glenn shunt is the most common palliation before the Fontan repair, especially in high-risk patients. We studied the influence of certain risk factors in bidirectional Glenn results, with and without an additional source of pulmonary blood flow.
Methods:
Between 1993 and 1998 twenty patients (6-53 months of age) underwent a bidirectional Glenn shunt as the intermediate repair for the Fontan procedure. Diagnoses were: 7 cases of double inlet single ventricle, 4 of tricuspid atresia, 3 of unbalanced AV septal defect, 4 of mitral atresia, 1 hypoplastic left heart syndrome and 1 TGA with hypoplasia of the right ventricle. 17 patients had undergone previous operations. Mean preoperative arterial oxygen saturation was 78.5%. In 6 patients an auxiliary source of pulmonary blood flow was added.
Results:
Hospital mortality was 15%. In 4 patients the bidirectional Glenn failed. By univariate analysis low weight, preoperative functional status and high pulmonary pressure were factors associated with early death. In bidirectional Glenn failure only the duration of ventilatory support was significant. By multivariate analysis, preoperative functional status and pulmonary pressure were significant. Mean postoperative arterial oxygen saturation at a mean follow-up of 10 months was 84%.
Conclusions:
Bidirectional Glenn shunt is an effective and low-risk palliation for patients with univentricular hearts. Only low weight and high pulmonary pressure were significant in hospital mortality, and we advise the association of an additional source of pulmonary blood flow in these patients at the start. Early extubation provides correct performance of the shunt.