Outcomes of bidirectional Glenn shunt for complicated cyanotic congenital heart disease
Objective To review the current outcomes of bidirectional Glenn (BDG)shunt in the treatment of children with complicated cyanotic congenital heart disease.Methods A total of 103 consecutive patients in high-risk Fontan procedure underwent Glenn shunt at our center from May 2008 to December 2012.The diagnoses included single ventricle (n = 61 ),transposition of great arteries (TGA,n= 12),corrected transposition of great arteries (c-TGA,n = 1 5 ),double outlet of right ventricle (DORV,n = 5 ),Ebstein anomaly (n =4),pulmonary atresia with intact ventricular septum (PA/VSD,n = 2 )and right ventricular hypoplasia (n = 4 ).There were 1 7 patients with heterotaxy syndrome. A total of 83 patients underwent unilateral operations and the remainder bilaterally.Among them,the procedure was performed with cardiopulmonary bypass (CPB)(n=50) and without (n = 56).Concomitant procedures included pulmonary artery reconstruction (n = 1 8 ), atrial septectomy (n = 1 5 ), pulmonary artery banding (n = 12 ), correction of total anomalous pulmonary venous connection (TAPVC, n = 6 ), atrioventricular valve repair (n = 6 ) and atrioventricular valve replacement (n = 2).Results Two early operative mortalities occurred with a rate of 1 .9%.The mean pulmonary artery pressure was 16.74 ± 2.95 mmHg. And the mean systematic oxygen saturation increased from 68 ± 13% to 84±6% at discharge.The mean follow-up period was 1 .5±1 .2 (0.5-3)years.During the observational period,1 patient died.The procedures included Glenn takedown plus B-T shunt (n = 1 )and atrioventricular valve replacement (n = 2 ). Twenty-six patients,considered optimal candidates,underwent Fontan operation.The remainders were well-palliated with an arterial oxygen saturation of 80±1 1 % at rest,cardiac function (NYHA) I-II class and no anastomotic stenosis.Conclusions Glenn shunt is an excellent temporary palliation prior to a Fontan operation for various cyanotic CHDs leading eventually to a single ventricle repair.It is of great importance for preventing an elevation of pulmonary arterial pressure and improving patient outcomes. Key words: Congenital heart disease Single ventricle Cardiac surgical procedures
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