Does the persistence of pulsatile antegrade pulmonary blood flow following bidirectional Glenn procedure affect long term outcome?

Abstract

To evaluate outcomes of the Glenn procedure with or without pulsatile antegrade pulmonary blood flow during palliation of patients with functionally single ventricles. The clinical records of 111 consecutive patients who underwent a bidirectional Glenn procedure for palliation of single ventricle morphologies at our institution between 1997 and 2010 were reviewed. We specifically excluded infants with the diagnosis of hypoplastic left heart syndrome. Following the Glenn procedure, there were 57 patients (Group 1) with and 54 (Group 2) without antegrade pulmonary blood flow. We reviewed their long term data from our database to determine whether the presence of forward flow after the Glenn procedure affected outcome. There was 1 early hospital death (in Group 1). The mean SaO2 at discharge was higher in Group 1 (83%±2 vs 78%±4; P<0.001). There was no difference in duration of chest drain insertion, length of intensive care and hospital stay between the two groups. The median follow-up time was 7.1 years (range, 1.7-14.9 years). Sixty-five patients underwent Fontan completion (35 from Group 1) a median of 3.6 years (Group 1) and 3.3 (Group 2) after the Glenn procedure. Three patients died following Fontan completion (1 from Group 1). The 5- and 10-year survival (95% CI) was 96% (84-98%) and 96% (84-98%) in Group 1, and 88% (74-94%) and 82% (66-91%) in Group 2, respectively (log-rank; P=0.03). There was no significant difference in SaO2 levels, or incidence of systemic atrioventricular valve regurgitation or ventricular dysfunction in survivors between groups at the last follow-up. We conclude that leaving antegrade flow following a Glenn procedure improves oxygen saturation significantly and while it does not impact on short term outcome or hospital stay, long-term outcome is significantly better.