ADDITIONAL PULMONARY BLOOD-FLOW WITH THE BIDIRECTIONAL GLENN ANASTOMOSIS - DOES IT MAKE A DIFFERENCE

Background. The bidirectional cavopulmonary shunt has become a mainsta y in the palliation of patients with a functional single-ventricle hea rt. However, there remain a number of unresolved issues regarding this procedure, many of which concern the response of the pulmonary vascul ature to this unique circulatory physiology. Among the issues of debat e are the role and effects of an additional source of pulmonary blood now. Methods. Between January 1990 and April 1997, 160 patients underw ent bidirectional cavopulmonary anastomosis. Median age at operation w as 7.8 months, and age ranged from 24 days to 43 years. An additional source of pulmonary blood now was included in 93 patients (58%). A ret rospective review of our experience with this cohort was performed wit h a focus on the role of additional pulmonary blood now. Results. Eigh t patients (5%) died in the early postoperative period, and the overal l early failure rate (death or take-down) was 7.5% (n = 12). Eleven ot her patients underwent early reoperation to decrease (n = 8) or increa se (n = 3) the amount of pulmonary blood flow. Early survivors were fo llowed up for a median of 23 months, during which time 5 patients died and 30 patients underwent Fontan completion, including early and late mortality, actuarial survival rates at 1 and 2 years were 91% and 88% , respectively. Conclusions. The bidirectional cavopulmonary shunt is a useful procedure in the early or intermediate-term management of pat ients with a functional univentricular heart. However, there is much s till to be learned about this unique physiologic system. The role of a ccessory pulmonary blood now remains unclear, as does the use of the b idirectional cavopulmonary shunt as long-term palliation. Pulmonary ar teriovenous fistulas are a serious concern, especially in young patien ts with heterotaxy syndrome. (C) 1998 by The Society of Thoracic Surge ons.