Bidirectional Glenn. Is accessory pulmonary blood flow good or bad?

Area of Science:

• Pediatric Cardiology
• Congenital Heart Surgery
• Cardiovascular Physiology

Background:

• The bidirectional Glenn (BDG) procedure is a critical stage in surgical management for single ventricle patients.
• A key debate in BDG surgery involves the management of accessory pulmonary blood flow (APBF) sources.
• APBF may increase systemic saturation but also adds volume load to the ventricle.

Purpose of the Study:

• To retrospectively assess the impact of accessory pulmonary blood flow (APBF) on patient outcomes following the bidirectional Glenn (BDG) procedure.
• To compare morbidity and mortality rates between patients with and without APBF during BDG surgery.

Main Methods:

• Retrospective review of 92 patients who underwent bidirectional Glenn (BDG) surgery between 1986 and 1994.
• Categorization of patients into two groups: those with maintained APBF (n=40) and those with eliminated APBF (n=52).
• Analysis of operative deaths, procedural failures, effusions, and overall mortality.

Main Results:

• Patients with APBF had a significantly higher incidence of effusions (19% vs. 2%, P < .05).
• Mortality was higher in the APBF group (17%) compared to the no-APBF group (4%).
• Overall successful operations were 85, with 3 operative deaths and 4 revisions required.

Conclusions:

• Elimination of accessory pulmonary blood flow (APBF) at the time of bidirectional Glenn (BDG) surgery is associated with reduced morbidity.
• The data strongly suggest that eliminating APBF leads to lower overall mortality rates in single ventricle patients post-BDG.
• Surgical strategies should consider the elimination of APBF to optimize outcomes after BDG procedures.