Factors determining early outcomes after the bidirectional superior cavopulmonary anastomosis.

Abstract

The bidirectional Glenn (BDG) procedure is a step in multistage palliation of univentricular heart (UVH). We aimed to report the factors determining the outcomes following BDG. Two hundred fifteen consecutive patients, 5.29±5years (range 1month to 38years, median 3years) of age, weighing 13±8.8kg (range 2.6 to 51kg, median 10kg) with variable forms of UVH underwent BDG from 2003 to 2013. Their clinical records were reviewed retrospectively. The most common anatomic diagnoses were tricuspid atresia (n=87, 40.5%) and double outlet right ventricle (n=78, 36%). Dextrocardia was present in 21 (9.86%) patients. Median left pulmonary (PA) and right PA diameters were 6 and 7mm, respectively. One hundred sixty-two (77%) patients received unilateral BDG, and 45 had bilateral BDG. The antegrade pulmonary blood flow was closed in 199 and was left open in 16 patients. Concomitant procedures were reconstruction of pulmonary arteries for non-confluent PA (n=28), atrial septectomy (n=15), atrioventricular valve repair (n=12) and repair of partial anomalous pulmonary venous connection (n=1). A total of 37% of patients (n=80) had a mean post-operative saturation of 90±3.2%. There were four (1.86%) early deaths. Mean Glenn pressure was 14.7±3.5 mmHg, and mean inotropic score and Vasoactive inotropic score (VIS) were 1.64±0.96 and 2.77±2.63, respectively. Mean intensive care unit stay was 24.1±26.4 (range 10-240)h, and mean duration of hospital stay was 7.15±3.2days. Mean saturation at the time of discharge was 92.4±2.2% and on follow-up was 82±2.16%. Follow-up cardiac catheterization data was available in 123 (60.3%). Sixty-nine (33.8%) patients underwent completion Fontan, and 135 patients were in follow-up or waiting for Fontan completion. BDG procedure can be performed safely with acceptable mortality. Age at presentation, pulmonary artery size and VIS were not related to mortality. Younger patients had similar outcomes but a longer hospital stay. Patients with preserved antegrade pulmonary blood flow had higher saturations. Those undergoing BDG without cardiopulmonary bypass had lower inotropic scores.