Original articlePediatric cardiacBidirectional Glenn and Antegrade Pulmonary Blood Flow: Temporary or Definitive Palliation?
Section snippets
Patients and Methods
This study is a retrospective review of three joint institutions’ experience with BCPA and APBF (Azienda di rilievo nazionale e di alta specializzazione [ARNAS] Civico - Palermo, Italy; Ospedale S. Vincenzo - Taormina, Italy; Istituto G.Gaslini – Genova, Italy). The study was approved by the respective Ethics Committees of the three involved institutions.
Early Results After BCPA With APBF
No in-hospital death occurred. The median duration of mechanical ventilation was 21.3 hours (range, 8.7 to 120.4 hours).
The following complications were observed: prolonged pleural effusions (defined as drainage for more than ten days or the need for multiple drainage procedures) in 22 patients (8.9%); SVC syndrome (defined as the clinical manifestation of an obstructed SVC impeding the normal blood drainage from head, neck, and arms) in 24 patients (9.7%); pericardial effusions in 30 patients
Comment
Classic Fontan operation [11], knowledge of the pathophysiology of single ventricle, failure of ventricular septation [12], Glenn anastomosis [13], BCPA with APBF, staged approach [14], and extracardiac Fontan [15] are all essential moments of a long, hurdled itinerary in the search of the best orthoterminal surgical correction [16] with, possibly, a zero mortality.
Over the years, the experience with the Fontan operation has increased [17, 18, 19] and has opened the way to a much wider
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Impact of Antegrade Pulmonary Blood Flow as Patients Progress Through Single-Ventricle Palliations
2023, Annals of Thoracic SurgeryInfluence of Antegrade Pulmonary Blood Flow on Outcomes of Superior Cavopulmonary Connection
2022, Annals of Thoracic SurgeryCitation Excerpt :Our study supports previous findings2-4 that there may be an increased risk of prolonged pleural drainage in patients with residual APBF, probably related to a combination of increased pulmonary blood flow, pulsatility, and higher pulmonary arterial pressures. Findings of previous studies have differed in regard to APBF effect on post-SCPC hospital LOS.3,9,10 Our study supports the finding that maintaining APBF does not significantly increase total hospital LOS despite the higher prevalence of prolonged pleural drainage.
Fate of Patients With Single Ventricles Who Do Not Undergo the Fontan Procedure
2022, Annals of Thoracic SurgeryCommentary: Flowers against nonflowers
2021, Journal of Thoracic and Cardiovascular SurgeryThe impact of additional antegrade pulmonary blood flow at bidirectional Glenn shunt on long-term outcomes
2021, Journal of Thoracic and Cardiovascular SurgeryCitation Excerpt :Our study findings are in accord with these previous reports. However, among patients with APBF, there was high morbidity in the form of a higher incidence of prolonged effusions8,12-14,20 and longer hospital stay.8,13,20 We observed a higher incidence of the combined morbidity including prolonged effusion and readmission for effusion in patients with APBF.