Skip to main content

Advertisement

SpringerLink
Log in

A Comparison of Bidirectional Glenn vs. Hemi-Fontan Procedure: An Analysis of the Single Ventricle Reconstruction Trial Public Use Dataset

  • Original Article
  • Published:
Pediatric Cardiology Aims and scope Submit manuscript

Abstract

Patients with single ventricle (SV) heart defects have two primary surgical options for superior cavopulmonary connection (SCPC): bidirectional Glenn (BDG) and hemi-Fontan (HF). Outcomes based on type of SCPC have not been assessed in a multi-center cohort. This retrospective cohort study uses the Single Ventricle Reconstruction (SVR) Trial public use dataset. Infants who survived to SCPC were evaluated through 1 year of age, based on type of SCPC. The primary outcome was transplant-free survival at 1 year. The cohort included 343 patients undergoing SCPC across 15 centers in North America; 250 (73%) underwent the BDG. There was no difference between the groups in pre-SCPC clinical characteristics. Cardiopulmonary bypass times were longer [99 min (IQR 76, 126) vs 81 min (IQR 59, 116), p < 0.001] and use of deep hypothermic circulatory arrest (DHCA) more prevalent (51% vs 19%, p < 0.001) with HF. Patients who underwent HF had a higher likelihood of experiencing more than one post-operative complication (54% vs 41%, p = 0.05). There were no other differences including the rate of post-operative interventional cardiac catheterizations, length of stay, or survival at discharge, and there was no difference in transplant-free survival out to 1 year of age. Mortality after SCPC is low and there is no difference in mortality at 1 year of age based on type of SCPC. Differences in support time and post-operative complications support the preferential use of the BDG, but additional longitudinal follow-up is necessary to understand whether these differences have implications for long-term outcomes.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1

Similar content being viewed by others

Abbreviations

BDG:

Bidirectional Glenn shunt

CPB:

Cardiopulmonary bypass

DHCA:

Deep hypothermic circulatory arrest

HF:

Hemi-Fontan procedure

HLHS:

Hypoplastic left heart syndrome

LOS:

Hospital length of stay

PA:

Pulmonary artery

RA:

Right atrium

RV:

Right ventricle

SCPC:

Superior cavopulmonary connection

SV:

Single ventricle heart disease

SVC:

Superior vena cava

SVR:

Single ventricle reconstruction trial

References

  1. Angelini A, Frescura C, Stellin G, Thiene G (1998) Cavopulmonary anastomosis in staging toward fontan operation: pathologic substrates. Ann Thorac Surg 66:659–663

    Article  CAS  Google Scholar 

  2. Bridges ND, Jonas RA, Mayer JE, et al (1990) Bidirectional cavopulmonary anastomosis as interim palliation for high-risk Fontan candidates. Early results. Circulation 82:IV170–6

  3. Feinstein JA, Benson DW, Dubin AM et al (2012) Hypoplastic left heart syndrome: current considerations and expectations. J Am Coll Cardiol 59:S1–42. https://doi.org/10.1016/j.jacc.2011.09.022

    Article  PubMed  PubMed Central  Google Scholar 

  4. Eckhauser A, Pasquali SK, Ravishankar C et al (2018) Variation in care for infants undergoing the stage II palliation for hypoplastic left heart syndrome. Cardiol Young 28:1109–1115. https://doi.org/10.1017/S1047951118000999

    Article  PubMed  PubMed Central  Google Scholar 

  5. Meza JM, Hickey EJ, Blackstone EH et al (2017) The optimal timing of stage 2 palliation for hypoplastic left heart syndrome. Circulation 136:1737–1748. https://doi.org/10.1161/CIRCULATIONAHA.117.028481

    Article  PubMed  PubMed Central  Google Scholar 

  6. Jonas RA (1994) Indications and timing for the bidirectional Glenn shunt versus the fenestrated Fontan circulation. J Thorac Cardiovasc Surg 108:522–524

    Article  CAS  Google Scholar 

  7. Pridjian AK, Mendelsohn AM, Lupinetti FM et al (1993) Usefulness of the bidirectional Glenn procedure as staged reconstruction for the functional single ventricle. Am J Cardiol 71:959–962

    Article  CAS  Google Scholar 

  8. Alejos JC, Williams RG, Jarmakani JM et al (1995) Factors influencing survival in patients undergoing the bidirectional Glenn anastomosis. Am J Cardiol 75:1048–1050. https://doi.org/10.1016/S0002-9149(99)80722-X

    Article  CAS  PubMed  Google Scholar 

  9. Douglas WI, Goldberg CS, Mosca RS et al (1999) Hemi-Fontan procedure for hypoplastic left heart syndrome: outcome and suitability for Fontan. Ann Thorac Surg 68:1361–1368

    Article  CAS  Google Scholar 

  10. Pizarro C, De Leval MR (1998) Surgical variations and flow dynamics in cavopulmonary connections: a historical review. Semin Thorac Cardiovasc Surg Pediatr Card Surg Annu 1:53–60

    Article  Google Scholar 

  11. Lee TM, Aiyagari R, Hirsch JC et al (2012) Risk factor analysis for second-stage palliation of single ventricle anatomy. Ann Thorac Surg 93:614–619. https://doi.org/10.1016/j.athoracsur.2011.10.012

    Article  PubMed  Google Scholar 

  12. Malhotra SP, Dunbar Ivy D, Mitchell MB et al (2008) Performance of cavopulmonary palliation at elevated altitude midterm outcomes and risk factors for failure. Circulation. https://doi.org/10.1161/CIRCULATIONAHA.107.751784

    Article  PubMed  PubMed Central  Google Scholar 

  13. Carlo WF, Carberry KE, Heinle JS et al (2011) Interstage attrition between bidirectional Glenn and Fontan palliation in children with hypoplastic left heart syndrome. J Thorac Cardiovasc Surg 142:511–516. https://doi.org/10.1016/j.jtcvs.2011.01.030

    Article  PubMed  Google Scholar 

  14. Alsoufi B, Manlhiot C, Awan A et al (2012) Current outcomes of the Glenn bidirectional cavopulmonary connection for single ventricle palliation. Eur J Cardio-Thoracic Surg 42:42–49. https://doi.org/10.1093/ejcts/ezr280

    Article  Google Scholar 

  15. Schwartz SM, Lu M, Ohye RG et al (2014) Risk factors for prolonged length of stay after the stage 2 procedure in the single-ventricle reconstruction trial. J Thorac Cardiovasc Surg 147:1791–1798.e4. https://doi.org/10.1016/j.jtcvs.2013.07.063

    Article  PubMed  Google Scholar 

  16. Hansen JH, Uebing A, Furck AK et al (2011) Risk factors for adverse outcome after superior cavopulmonary anastomosis for hypoplastic left heart syndrome. Eur J Cardio-Thorac Surg. https://doi.org/10.1016/j.ejcts.2011.02.044

    Article  Google Scholar 

  17. Ohye RG, Sleeper LA, Mahony L et al (2010) Comparison of shunt types in the norwood procedure for single-ventricle lesions. N Engl J Med 362:1980–1992. https://doi.org/10.1056/NEJMoa0912461

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  18. Talwar S, Nair VV, Choudhary SK, Airan B (2014) The Hemi-Fontan operation: a critical overview. Ann Pediatr Cardiol 7:120–125. https://doi.org/10.4103/0974-2069.132480

    Article  PubMed  PubMed Central  Google Scholar 

  19. Kogon BE, Plattner C, Leong T et al (2008) The bidirectional Glenn operation: a risk factor analysis for morbidity and mortality. J Thorac Cardiovasc Surg 136:1237–1242. https://doi.org/10.1016/j.jtcvs.2008.05.017

    Article  PubMed  Google Scholar 

  20. Wernovsky G, Stiles KM, Gauvreau K et al (2000) Cognitive development after the Fontan operation. Circulation 102:883–889. https://doi.org/10.1161/01.CIR.102.8.883

    Article  CAS  PubMed  Google Scholar 

  21. Lasa JJ, Glatz AC, Daga A, Shah M (2014) Prevalence of arrhythmias late after the Fontan operation. Am J Cardiol 113:1184–1188. https://doi.org/10.1016/j.amjcard.2013.12.025

    Article  PubMed  Google Scholar 

  22. Balaji S, Daga A, Bradley DJ et al (2014) An international multicenter study comparing arrhythmia prevalence between the intracardiac lateral tunnel and the extracardiac conduit type of Fontan operations. J Thorac Cardiovasc Surg 148:576–581. https://doi.org/10.1016/j.jtcvs.2013.08.070

    Article  PubMed  Google Scholar 

  23. Reichlin A, Prêtre R, Dave H et al (2014) Postoperative arrhythmia in patients with bidirectional cavopulmonary anastomosis. Eur J Cardio-thoracic Surg 45:620–624. https://doi.org/10.1093/ejcts/ezt420

    Article  Google Scholar 

Download references

Acknowledgements

This work was supported in part by the Cardiac Center Clinical Research Core at the Children’s Hospital of Philadelphia. The NIH/NHLBI Pediatric Heart Network Single Ventricle Reconstruction Trial dataset was used in preparation of this work. Data were downloaded from https://www.pediatric heartnetwork.org/ForResearchers/PHNPublicUseDatasets /SingleVentricleReconstruction Trial.aspx. The authors acknowledge all those who have contributed to the Pediatric Heart Network.

Author information

Authors and Affiliations

  1. Division of Cardiology, Cardiac Center, The Children’s Hospital of Philadelphia, University of Pennsylvania Perelman School of Medicine, 3400 Civic Center Boulevard, Suite 8NW90, Philadelphia, PA, 19104, USA

    Jonathan B. Edelson, Chitra Ravishankar, Monique M. Gardner, Maryam Y. Naim, Andrew C. Glatz & David J. Goldberg

  2. Healthcare Analytics Unit, The Children’s Hospital of Philadelphia, Philadelphia, PA, USA

    Heather Griffis, Xuemei Zhang & Jennifer Faerber

  3. Division of Critical Care and Anesthesiology, The Children’s Hospital of Philadelphia, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA

    Monique M. Gardner & Maryam Y. Naim

  4. Division of Cardiothoracic Surgery, Cardiac Center, The Children’s Hospital of Philadelphia, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA

    Christopher E. Macsio

  5. Center for Pediatric Clinical Effectiveness, The Children’s Hospital of Philadelphia, Philadelphia, PA, USA

    Andrew C. Glatz

Authors
  1. Jonathan B. Edelson
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Chitra Ravishankar
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Heather Griffis
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Xuemei Zhang
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Jennifer Faerber
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Monique M. Gardner
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Maryam Y. Naim
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Christopher E. Macsio
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Andrew C. Glatz
    View author publications

    You can also search for this author in PubMed Google Scholar

  10. David J. Goldberg
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Jonathan B. Edelson.

Ethics declarations

Conflict of interest

The authors have no relevant financial disclosures or conflicts of interest to declare.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Edelson, J.B., Ravishankar, C., Griffis, H. et al. A Comparison of Bidirectional Glenn vs. Hemi-Fontan Procedure: An Analysis of the Single Ventricle Reconstruction Trial Public Use Dataset. Pediatr Cardiol 41, 1166–1172 (2020). https://doi.org/10.1007/s00246-020-02371-6

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00246-020-02371-6

Keywords

Search

Navigation