Effect of accessory pulmonary blood flow on survival after the bidirectional Glenn procedure

Background-The bidirectional Glenn procedure (BDG) is used in the staged su rgical management of patients with a functional single ventricle. Controver sy 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 influen ce 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 o f APBF, whereas 56 patients had either a shunt or a patent right ventricula r outflow tract intentionally left in place to augment the pulmonary blood flow provided by the BDG. The operative mortality rate was 2.2% without APB F 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-Me ier curves in favor of patients in whom APBF was eliminated (P<0.02). One h undred seven patients have subsequently undergone completion of their Fonta n 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.