Numerical Investigation of the Effect of Additional Pulmonary Blood Flow on Patient-Specific Bilateral Bidirectional Glenn Hemodynamics

Background —The bidirectional Glenn procedure (BDG) is used in the staged surgical management of patients with a functional single ventricle. Controversy exists regarding whether accessory pulmonary blood flow (APBF) should be left at the time of BDG to augment systemic saturation or be eliminated to reduce volume load of the ventricle. The present study was a retrospective review of patients undergoing BDG that was conducted to assess the influence of APBF on survival rates. Methods and Results —From 1986 through 1998, 149 patients have undergone BDG at our institution. Ninety-three patients had elimination of all sources of APBF, whereas 56 patients had either a shunt or a patent right ventricular outflow tract intentionally left in place to augment the pulmonary blood flow provided by the BDG. The operative mortality rate was 2.2% without APBF and 5.4% with APBF. The late mortality rate was 4.4% without APBF and 15.1% with APBF. Actuarial analysis demonstrates a divergence of the Kaplan-Meier curves in favor of patients in whom APBF was eliminated ( P <0.02). One hundred seven patients have subsequently undergone completion of their Fontan operation, so the actuarial analysis includes the operative risk of this second operation. Conclusions —The results suggest that the elimination of APBF at the time of BDG may confer a long-term advantage for patients with a functional single ventricle.

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Targeted Increase in Pulmonary Blood Flow in a Bidirectional Glenn Circulation

Seminars in Thoracic and Cardiovascular Surgery ◽

10.1053/j.semtcvs.2018.02.001 ◽

2018 ◽

Vol 30 (2) ◽

pp. 182-188 ◽

Cited By ~ 6

Author(s):

Samuel L. Casella ◽

Aditya Kaza ◽

Pedro del Nido ◽

James E. Lock ◽

Audrey C. Marshall

Keyword(s):

Blood Flow ◽

Pulmonary Blood Flow ◽

Bidirectional Glenn

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Bidirectional Glenn With Additional Pulmonary Blood Flow: Systematic Review and Evidence-Based Recommendations

Journal of Cardiac Surgery ◽

10.1111/jocs.12592 ◽

2015 ◽

Vol 30 (9) ◽

pp. 724-730 ◽

Cited By ~ 4

Author(s):

Abdullah A. Alghamdi

Keyword(s):

Systematic Review ◽

Blood Flow ◽

Pulmonary Blood Flow ◽

Evidence Based ◽

Bidirectional Glenn

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The impact of additional antegrade pulmonary blood flow at bidirectional Glenn shunt on long-term outcomes

Journal of Thoracic and Cardiovascular Surgery ◽

10.1016/j.jtcvs.2021.01.022 ◽

2021 ◽

Cited By ~ 1

Author(s):

Jae Suk Baek ◽

Chun Soo Park ◽

Eun Seok Choi ◽

Tae-Jin Yun ◽

Bo Sang Kwon ◽

...

Keyword(s):

Blood Flow ◽

Pulmonary Blood Flow ◽

Long Term Outcomes ◽

Glenn Shunt ◽

Bidirectional Glenn ◽

Bidirectional Glenn Shunt ◽

The Impact

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Results of Additional Pulsatile Pulmonary Blood Flow with Bidirectional Glenn Cavopulmonary Anastomosis: Positive Effect on Main Pulmonary Artery Growth and Less Need for Fontan Conversion

The Heart Surgery Forum ◽

10.1532/hsf98.20121078 ◽

2013 ◽

Vol 16 (1) ◽

pp. 30 ◽

Cited By ~ 3

Author(s):

Orhan Saim Demirtürk ◽

Murat Güvener ◽

İsa Coşkun ◽

Selman Vefa Yıldırım

Keyword(s):

Blood Flow ◽

Pulmonary Artery ◽

Oxygen Pressure ◽

Pulmonary Blood Flow ◽

Main Pulmonary Artery ◽

Bidirectional Glenn ◽

Cavopulmonary Anastomosis ◽

Cavopulmonary Shunt ◽

Partial Oxygen

Background: Additional antegrade pulsatile pulmonary blood flow obtained by leaving the main pulmonary artery patent during bidirectional cavopulmonary shunt has been shown to give additional benefits to the bidirectional Glenn cavopulmonary anastomosis. We retrospectively evaluated our 20-patient pulsatile Glenn series in order to find out whether these salutary effects were valid or not. Methods: Between June 2007 and November 2011, 20 patients (11 girls and 9 boys) with single-ventricle physiology underwent bidirectional cavopulmonary anastomosis. The additional source of blood flow was through the unligated main pulmonary artery in all patients. A retrospective review of our surgical experience was performed focusing on the role of additional pulmonary flow. Medical records and perioperational and postoperative follow-up data including clinical outcomes were retrospectively retrieved and analyzed. Results: Two patients died in the early postoperative period. One patient died in the follow-up period. Mean follow-up time was 23.9 ± 15.7 months. No superior vena cava syndrome and no increase in pulmonary vascular resistance were observed. Improvement of partial oxygen pressure after pulsatile Glenn has been shown in all patients (P = .00). At a mean interval of 22.9 months, main pulmonary artery size continued to increase after pulsatile Glenn cavopulmonary anastomosis (P = .028). Only 1 patient was converted to Fontan type circulation after pulsatile Glenn cavopulmonary anastomosis. Conclusions: The pulsatile cavopulmonary shunt is a useful procedure in the early and intermediate term management of patients with a functional univentricular heart. It improves partial oxygen pressure and the impact of pulsatility on the main pulmonary artery.

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Superior Cavopulmonary Anastomosis in Patients With Bilateral Superior Caval Veins: Use of a Rolled Pericardial Graft to Create a Single Caval Vein

World Journal for Pediatric and Congenital Heart Surgery ◽

10.1177/2150135118765888 ◽

2018 ◽

Vol 9 (4) ◽

pp. 446-450 ◽

Cited By ~ 1

Author(s):

Tran-Thuy Nguyen ◽

Ngoc-Thanh Le ◽

Quoc-Hung Doan

Keyword(s):

Blood Flow ◽

Surgical Technique ◽

Pulmonary Blood Flow ◽

Thrombus Formation ◽

Univentricular Heart ◽

Caval Vein ◽

Bidirectional Glenn ◽

Cavopulmonary Anastomosis ◽

Flow Through ◽

New Surgical Technique

We propose a new surgical technique for superior cavopulmonary anastomosis in patients with functionally univentricular heart and bilateral superior caval veins. One of the reasons for failure of bidirectional Glenn shunts in patients with bilateral superior caval veins is the small caliber of one or both veins, with limited flow through each cavopulmonary anastomosis that can easily result in torsion, blockage, or clot formation. The conversion of two small superior caval veins into a single confluence which is large enough to connect with the pulmonary artery (PA) can resolve this problem. We present our experience with two cases in which a rolled pericardial graft was used to create a single caval vein to provide balanced pulmonary blood flow and yield growth of the central PA as well as reducing the likelihood of thrombus formation.

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