Bidirectional Glenn and Antegrade Pulmonary Blood Flow: Temporary or Definitive Palliation?

Davide F. Calvaruso, Antonio Rubino, Salvatore Ocello, Nicoletta Salviato, Diego Guardì, David F. Petruccelli, Adriano Cipriani, Khalil Fattouch, Salvatore Agati, Carmelo Mignosa, Lucio Zannini, Carlo F. Marcelletti

Research output: Contribution to journalArticlepeer-review


Background: We sought to investigate the role of the bidirectional Glenn with antegrade pulmonary blood flow in the surgical history of children with univentricular hearts. Methods: A series of 246 patients, from three joint institutions, having univentricular heart with restricted but not critical pulmonary blood flow received a bidirectional cavopulmonary shunt with additional forward pulmonary blood flow. All patients have been studied according to their progression, or not, to Fontan operation. Two hundred and eight (84.5%) patients underwent bidirectional cavopulmonary anastomosis as primary palliation. Twenty patients (8.1%) with previous pulmonary artery banding were also enrolled in the study. Patients who had received additional pulmonary blood flow through a previous systemic to pulmonary artery shunt for the critical pulmonary blood flow were excluded. Results: No in-hospital death occurred. Follow-up was complete at 100%. Mean follow-up was 4.2 ± 2.8 years (range, 6 months to 7 years). During the observational period 73 (29.7%) patients, considered optimal candidates, underwent Fontan completion for increasing cyanosis and (or) hematocrit and (or) fatigue with exertion. Three patients expired after total cavopulmonary connection (3 of 73; 4.1% mortality rate). The remaining 173 (70.3%) patients are alive with initial palliation. All patients were still well palliated with an arterial oxygen saturation at rest about 90%. Conclusions: According to our experience and results, bidirectional Glenn with antegrade pulmonary blood flow may be an excellent temporary palliation prior to a Fontan operation, which can be performed at the onset of symptoms. Bidirectional Glenn may also be the best possible palliation for a suboptimal candidate for Fontan.

Original languageEnglish
Pages (from-to)1389-1396
Number of pages8
JournalAnnals of Thoracic Surgery
Issue number4
Publication statusPublished - Apr 2008

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Surgery


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