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Impact of bilateral superior venae cavae on outcome of staged Fontan procedure
Yusuke Ando1, Koji Fukae1, Kazuto Hirayama1
1Department of Pediatric Cardiac Surgery, Kumamoto City Hospital, Kumamoto, Japan.
Insights
Bilateral bidirectional Glenn procedures (BDG) are safe for patients with two superior venae cavae, showing no increased risk of thrombosis or pulmonary artery issues. Outcomes remain comparable to unilateral BDG, supporting its use in complex congenital heart cases.
Area of Science:
- Cardiovascular Surgery
- Pediatric Cardiology
- Congenital Heart Disease
Background:
- Bilateral superior venae cavae can complicate bidirectional Glenn procedures (BDG).
- Potential risks include blood flow stagnation, thrombosis, and impaired pulmonary artery growth.
Purpose of the Study:
- To evaluate the safety and efficacy of bilateral BDG compared to unilateral BDG.
- To assess the impact on thrombosis, pulmonary artery development, and Fontan procedure outcomes.
Main Methods:
- Retrospective analysis of 40 patients undergoing BDG (January 2004 - April 2011).
- Cohort divided into bilateral BDG (n=13) and unilateral BDG (n=27) groups.
- Analysis of operative, angiographic, and follow-up data.
Main Results:
- No thrombosis occurred in either group.
- Actuarial survival rates and central pulmonary artery index showed no significant differences.
- Freedom from reintervention for pulmonary artery stenosis was comparable, with similar Fontan completion rates.
Conclusions:
- Bilateral BDG is a safe surgical option.
- It does not increase risks of thrombosis or central pulmonary artery hypoplasia.
- Outcomes are comparable to unilateral BDG, supporting its use before the Fontan procedure.
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.
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