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Additional pulmonary blood flow with the bidirectional Glenn anastomosis: does it make a difference?
D B McElhinney1, S M Marianeschi, V M Reddy
1Division of Cardiothoracic Surgery, University of California, San Francisco 94143-0118, USA.
The Annals of Thoracic Surgery
|September 2, 1998
Summary
The bidirectional cavopulmonary shunt is effective for single-ventricle heart palliation, but the role of additional pulmonary blood flow requires further study. Long-term outcomes and risks like pulmonary arteriovenous fistulas need more investigation.
Area of Science:
- Cardiovascular Surgery
- Pediatric Cardiology
- Congenital Heart Disease
Background:
- The bidirectional cavopulmonary shunt is a key procedure for single-ventricle heart palliation.
- Unresolved issues persist regarding pulmonary vasculature response and the impact of additional pulmonary blood flow.
Purpose of the Study:
- To evaluate the role and effects of additional pulmonary blood flow in patients undergoing bidirectional cavopulmonary anastomosis.
- To assess the early and intermediate-term outcomes of this surgical approach.
Main Methods:
- Retrospective review of 160 patients who underwent bidirectional cavopulmonary anastomosis between 1990 and 1997.
- Analysis focused on the use and impact of an additional source of pulmonary blood flow in 93 patients (58%).
Main Results:
- Early postoperative mortality was 5%, with an overall early failure rate of 7.5%.
- Actuarial survival rates at 1 and 2 years were 91% and 88%, respectively.
- Pulmonary blood flow adjustments were needed in 11 patients early post-operation.
Conclusions:
- The bidirectional cavopulmonary shunt is beneficial for intermediate-term management of functional univentricular hearts.
- The significance of accessory pulmonary blood flow and long-term palliation efficacy remain unclear.
- Pulmonary arteriovenous fistulas are a notable risk, particularly in young patients with heterotaxy syndrome.