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The role of the Glenn shunt in patients undergoing the Fontan operation
Insights
The Glenn shunt may improve outcomes for patients undergoing the Fontan operation, reducing complications and hospital stays, especially for those with complex heart conditions.
Area of Science:
- Pediatric Cardiac Surgery
- Congenital Heart Disease Management
Background:
- The Fontan operation is a palliative procedure for complex single-ventricle congenital heart disease.
- Optimizing outcomes and minimizing complications after the Fontan procedure remain critical challenges.
Purpose of the Study:
- To evaluate the impact of a prior Glenn shunt on the outcomes of the Fontan operation in pediatric patients.
- To assess the role of the Glenn shunt in reducing postoperative complications and hospital stay.
Main Methods:
- Retrospective review of 27 pediatric patients undergoing the Fontan operation.
- Comparison of outcomes between patients with and without a prior Glenn shunt.
Main Results:
- The overall mortality rate was 11.1% (3/27), including one early and two late deaths.
- Patients with a Glenn shunt had shorter postoperative hospital stays (average 9.5 days) and fewer effusions compared to those without (average 17.5 days).
- The Glenn shunt was crucial in managing major complications in four patients.
Conclusions:
- An established Glenn shunt appears to play a significant role in achieving minimal postoperative hemodynamic instability, effusions, and mortality after the Fontan operation.
- The Glenn shunt should be considered for patients who are less than ideal candidates for the Fontan procedure.
Abstract:
Twenty-seven patients (3 to 22 years) underwent the Fontan operation. Seventeen had tricuspid atresia and 10 had other complex lesions. Sixteen patients had a Glenn shunt (12 prior to, three simultaneous with, and one following the Fontan operation). One early death (3.7%) occurred in a 4 1/2-year-old child with tricuspid atresia II-C, previous pulmonary artery banding, and a closing ventricular septal defect (80 mm Hg gradient). There were two late deaths (7.4%) from Candida sepsis, after 4 and 6 months, respectively. The 24 patients who survived the Fontan operation had postoperative hospital stays of 6 to 90 days (average 18). Patients with tricuspid atresia and an established Glenn shunt (nine patients, Group I) had postoperative hospital stays of 7 to 19 days (average 9.5), and none had significant pleural or pericardial effusions. Patients with tricuspid atresia without a Glenn shunt (seven patients, Group II) had postoperative hospital stays of 6 to 60 days (average 17.5), with three having significant effusions. Of the patients with other complex lesions, all without an established Glenn shunt, five had significant effusions. Four additional major complications (two tricuspid patch disruptions with ineffective pulmonary blood flow and two complete occlusions of a valved conduit) were encountered in which the Glenn shunt proved lifesaving. We believe that an established Glenn shunt played a major role in attaining minimal postoperative hemodynamic instability, effusions, renal failure, and mortality in our patients. The Glenn shunt should be considered in patients who are less than ideal candidates for the Fontan operation.