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Published on: July 18, 2014
Effectiveness of Bidirectional Glenn Shunt Placement for Palliation in Complex Congenitally Corrected Transposed
Insights
Bidirectional Glenn shunt placement offers a favorable palliative option for complex congenitally corrected transposition, improving oxygen saturation without impacting ventricular function. This procedure allows for subsequent Fontan completion or anatomic repair, or can serve as long-term palliation.
Area of Science:
- Cardiovascular Surgery
- Pediatric Cardiology
- Congenital Heart Disease
Background:
- Complex congenitally corrected transposition presents significant surgical challenges.
- Palliative strategies are crucial for managing these complex cases.
Purpose of the Study:
- To evaluate the outcomes of bidirectional Glenn shunt placement as a palliative procedure for complex congenitally corrected transposition.
- To assess the feasibility of subsequent Fontan completion or anatomic repair after palliation.
Main Methods:
- Retrospective review of 50 patients with congenitally corrected transposition, left ventricular outflow tract obstruction, and ventricular septal defect undergoing bidirectional Glenn shunt placement.
- Patients were categorized into three groups based on subsequent surgical interventions: Fontan completion, anatomic repair, or prolonged palliation.
Main Results:
- Bidirectional Glenn shunt placement resulted in a significant increase in mean oxygen saturation (79.5% to 94.1%, P <0.001) without any operative mortality or ventricular dysfunction.
- Two late deaths occurred in the Fontan completion group; otherwise, patients maintained good ventricular function and improved oxygen saturation at long-term follow-up.
- The procedure facilitated subsequent Fontan completion (median 2.1 years) and anatomic repair (median 1.1 years).
Conclusions:
- Bidirectional Glenn shunt placement is a safe and effective palliative option for complex congenitally corrected transposition.
- This approach provides favorable short- and long-term outcomes, improving oxygenation and allowing for staged surgical management.
- The procedure is a viable option for both staged repair and long-term palliation in select patients.
Abstract:
Surgery for complex congenitally corrected transposed great arteries is one of the greatest challenges in cardiovascular surgery. We report our experience with bidirectional Glenn shunt placement as a palliative procedure for complex congenitally corrected transposition. We retrospectively identified 50 consecutive patients who had been diagnosed with congenitally corrected transposition accompanied by left ventricular outflow tract obstruction and ventricular septal defect and who had then undergone palliative bidirectional Glenn shunt placement at our institution from January 2005 through December 2014. Patients were divided into 3 groups according to subsequent surgeries: Fontan completion (total cavopulmonary connection, 13 patients) (group 1), anatomic repair (hemi-Mustard and Rastelli procedures without Glenn takedown, 11 patients) (group 2), and prolonged palliation (no further surgery, 26 patients) (group 3). After shunt placement, no patient died or had ventricular dysfunction. Overall, mean oxygen saturation increased significantly from 79.5% ± 13.5% preoperatively to 94.1% ± 7.3% (P <0.001). The median time from shunt placement to Fontan completion and anatomic repair, respectively, was 2.1 years (range, 1.6-5.2 yr) and 1.1 years (range, 0.6-2.4 yr). Only 2 late deaths occurred, both in group 1. In group 3, time from shunt placement to latest follow-up was 4.5 years (range, 2.3-8 yr). At latest follow-up, mean oxygen saturation was 91.6% ± 10.3%, and no patients had impaired ventricular function. Bidirectional Glenn shunt placement as an optional palliative procedure for complex congenitally corrected transposition has favorable outcomes. Later, patients can feasibly be treated by Fontan completion or anatomic repair. Use of a bidirectional Glenn shunt for open-ended palliation is also acceptable.
