Preserved Antegrade Pulmonary Blood Flow in Bidirectional Glenn: Outcomes and Considerations for Staged Palliation.
Source: PubMed, NCBI / U.S. National Library of Medicine
Preservation of antegrade pulmonary blood flow (APBF) at the time of bidirectional Glenn (BDG) is believed to promote pulmonary artery (PA) growth and prevent pulmonary arteriovenous fistulas (PAVFs). However, its clinical impact on early and midterm outcomes remains unclear. This study aimed to evaluate the impact of APBF preservation on early and midterm outcomes. This single-center retrospective study included 47 patients who underwent BDG between 2017 and 2025. Patients were categorized by APBF status: eliminated (APBF-, n = 30) or preserved (APBF+, n = 17). Early and midterm outcomes and hemodynamic changes between BDG and pre-Fontan evaluations were compared. In early postoperative outcomes, the APBF+ group had significantly longer mechanical ventilation (0 days vs 1 day, P = .03). At the pre-Fontan evaluation, no significant differences were observed in PA index or arterial oxygen saturation. However, the APBF+ group showed significantly higher Qp/Qs (0.64 vs 0.82, P = .004), and higher BNP (15.16 vs 26.02 pg/mL, P = .05). Regarding midterm outcomes, AVV surgery (3.3 vs 17.6%, P = .13) and interventions for venovenous collaterals (4.5 vs 30.0%, P = .08) tended to be more frequent in the APBF+ group. No PAVF interventions were required in either group. Fontan completion and survival were comparable. No group × time interaction was found in hemodynamic changes. Preserving APBF did not improve pulmonary artery development or hemodynamics and was associated with incre
Abstract
Preservation of antegrade pulmonary blood flow (APBF) at the time of bidirectional Glenn (BDG) is believed to promote pulmonary artery (PA) growth and prevent pulmonary arteriovenous fistulas (PAVFs). However, its clinical impact on early and midterm outcomes remains unclear. This study aimed to evaluate the impact of APBF preservation on early and midterm outcomes. This single-center retrospective study included 47 patients who underwent BDG between 2017 and 2025. Patients were categorized by APBF status: eliminated (APBF-, n = 30) or preserved (APBF+, n = 17). Early and midterm outcomes and hemodynamic changes between BDG and pre-Fontan evaluations were compared. In early postoperative outcomes, the APBF+ group had significantly longer mechanical ventilation (0 days vs 1 day, P = .03). At the pre-Fontan evaluation, no significant differences were observed in PA index or arterial oxygen saturation. However, the APBF+ group showed significantly higher Qp/Qs (0.64 vs 0.82, P = .004), and higher BNP (15.16 vs 26.02 pg/mL, P = .05). Regarding midterm outcomes, AVV surgery (3.3 vs 17.6%, P = .13) and interventions for venovenous collaterals (4.5 vs 30.0%, P = .08) tended to be more frequent in the APBF+ group. No PAVF interventions were required in either group. Fontan completion and survival were comparable. No group × time interaction was found in hemodynamic changes. Preserving APBF did not improve pulmonary artery development or hemodynamics and was associated with increased volume load and interstage interventions. Selective rather than routine APBF preservation is recommended.