Outcomes of bidirectional Glenn surgery done without prior cardiac catheterization

Abstract

Background Cardiac catheterization is usually done routinely in patients with univentricular hearts before palliative Bidirectional Glenn (BDG) surgery. The objective of this study was to compare the outcomes of patients with physiological univentricular hearts and restrictive pulmonary flow that did not undergo routine cardiac catheterization before BDG with the patients that did have cardiac catheterization done. We retrospectively reviewed the data of all patients with single ventricle physiology and restrictive pulmonary blood flow who underwent BDG surgery from January 2016 till December 2020. Patients were divided into two groups: the catheterization and the non-catheterization groups. Results Out of 93 patients, 25 (27%) underwent BDG surgery without prior cardiac catheterization. The median age of patients was ten months, interquartile range (IQR) was 5–18 months. Tricuspid atresia represented 36% of the non-catheterization group, while unbalanced atrioventricular septal defect and hypoplastic left heart syndrome represented 19% and 17.6% of the catheterization group. No patients in the catheterization group were excluded from further BDG surgery based on the catheterization data. Moreover, no significant differences were found between the patients' groups regarding the length of hospital stay, length of intensive care unit stay, postoperative oxygen saturation, or survival (P = 0.266, P = 0.763, P = 0.543, P = 0456). Conclusions Although pre-BDG cardiac catheterization is the routine and standard practice, in certain situations, some patients with single ventricle physiology and restrictive pulmonary blood flow may go directly to BDG without cardiac catheterization if noninvasive imaging is satisfactory on a case-by-case basis and according to center experience. Pre-BDG catheterization could be reserved for patients with limited echocardiographic studies, high-risk patients, or those indicated for catheter intervention before BDG surgery.

Bidirectional glenn surgery without palliative pulmonary artery banding in univentricular heart with unrestricted pulmonary flow. Retrospective multicenter experience

“…As reported in the literature, a low PVRi (≤ 3 WU.m2) is one of the characteristics linked with favorable outcomes following BDG surgery [ 2 , 11 ]. In this cohort, 11/16 patients in group 2 got direct BDG without initial PAB between the ages of 2 to 4 months.…”

“…As the PVR is likely at its minimal value at this age, this age may be optimal for performing direct BDG. It may be risky to perform direct BDG after six months or before two months of life because the PVRi may exceed the safe values (≤ 3 WU.m2) [ 2 , 11 , 12 ]. In this cohort, 3/16 patients in group 2 underwent direct BDG at 10–11 months and three patients before the age of 2 months; fortunately, all these patients had a PVRi ≤ 5 WU.m2 on room air and < 3 following vasoreactivity testing.…”

“…Patients with univentricular heart and unrestrictive pulmonary blood flow (UPBF) usually develop heart failure symptoms after the physiological decrease of pulmonary vascular resistance that occurs after birth [ 1 , 2 ]. Pulmonary vascular resistance (PVR) gradually decreases after birth and reaches its lowest value during the early few months of life.…”