BIDIRECTIONAL GLENN - IS ACCESSORY PULMONARY BLOOD-FLOW GOOD OR BAD

Background The bidirectional Glenn (BDG) is frequently used in the sta ged surgical management of single ventricle patients. Controversy exis ts whether accessory pulmonary blood flow (APBF) sources should be lef t at the time of the BDG to augment systemic saturation or should be e liminated to reduce volume load of the ventricle, The present study wa s a retrospective review to assess the influence of APBF on outcome af ter the BDG. Methods and Results Ninety-two patients have undergone BD G at our institute during the interval from 1986 through 1994. At the time of BDG, 40 patients had either a systemic-to-pulmonary artery shu nt or patent right ventricular outflow tract as an additional source o f pulmonary blood flow. Fifty-two patients had elimination of APBF. Th ere were three operative deaths (two with and one without APBF) and fo ur procedures (two in each group) that failed and required subsequent revision. Thus, there were 85 patients who underwent successful operat ion. Effusions (defined as chest tube drainage exceeding 7 days' durat ion) occurred in 8 of 85 patients; this complication was seen in 7 of 36 patients (19%) with APBF and 1 of 49 patients (2%) without APBF (P< .05). There were 11 deaths, including 6 patients (17%) with APBF, 2 pa tients (4%) without APBF, and 3 of the patients (75%) who had a failed BDG. Conclusions The data suggest that morbidity and mortality are lo wer in patients in whom APBF is eliminated at the time of the BDG.