Abstract 12033: Complications and Outcomes of Bilateral, Bidirectional, Glenn Shunts versus Unilateral, Bidirectional, Glenn Shunts
Background: It is not known if patients with bilateral, bidirectional, Glenn shunts (BBDG) are predisposed to lower oxygen saturations, need more catheter-based interventions or require earlier Fontan completions, when compared to patients with unilateral, bidirectional, Glenn shunts (UBDG). Objectives: We hypothesized that BBDG patients may manifest more complications and need more catheter interventions than UBDG patients.
Methods: We performed a retrospective analysis of records of 526 patients, 454 with UBDG and 72 with BBDG between January, 2000 and December, 2010, at The Children's Hospital of Philadelphia. The outcomes were compared using log-rank test, unpaired t test, Chi- Square test and Fisher's exact test.
Results: Twice as many patients required catheter interventions (p=0.01) and need for multiple interventions was much higher in BBDG group. Common interventions were thrombectomy, embolization and stent placement. Rate of catheter interventions in BBDG group with and without heterotaxy, were similar (33% vs. 26%, p =0.71). Cardiopulmonary bypass time was 55% longer in BBDG group compared to UBDG group, (p=0.0002). Mortality rate, average length of stay following Glenn operation, oxygen saturations at six-month follow up visit and time between Glenn and Fontan operations, were not significantly different between the two groups.
Conclusions: Increased need for catheter-based interventions in BBDG patients is a new and important finding. These patients may benefit from counseling specifically addressing this issue and more vigilant follow-up. Although not used presently, need for anticoagulation may need to be addressed in BBDG group. Earlier Fontan completion was not required in BBDG group. Increased bypass times in patients with BBDG are unavoidable, but may portend worse neurologic outcomes. Despite a higher incidence in BBDG group, heterotaxy did not pose as an increased risk factor for mortality or catheter interventions in this group.
- © 2012 by American Heart Association, Inc.