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Ann Thorac Surg 2007;83:1768-1773
© 2007 The Society of Thoracic Surgeons

Original Articles: Cardiovascular

Outcomes After Bidirectional Glenn Operation: Blalock-Taussig Shunt Versus Right Ventricle–to–Pulmonary Artery Conduit

Lillian Lai, MHA, MDa,c,*, Peter C. Laussen, MBBSa,c, Clifford L. Cua, MDa,c, David L. Wessel, MDa,c, John M. Costello, MDa,c, Pedro J. del Nido, MDb,d, John E. Mayer, MDb,d, Ravi R. Thiagarajan, MBBS, MPHa,c

a Department of Cardiology, Children’s Hospital Boston, Boston, Massachusetts
b Department of Cardiac Surgery, Children’s Hospital Boston, Boston, Massachusetts
c Department of Pediatrics, Harvard Medical School, Boston, Massachusetts
d Department of Surgery, Harvard Medical School, Boston, Massachusetts

Accepted for publication November 22, 2006.

* Address correspondence to Dr Lai, 401 Smyth Rd, Ottawa, Ontario K1M 2B5, Canada (Email: llai{at}cheo.on.ca).

Background: There are distinct physiologic differences between patients with single-ventricle lesions who have undergone the Norwood procedure with a right ventricle–to–pulmonary artery conduit (NW-RVPA) compared with those patients who have undergone the Norwood operation with a Blalock-Taussig shunt (NW-BTS). We evaluated bidirectional Glenn operation outcomes and compared the two groups to assess whether the type of Norwood operation influenced outcomes.

Methods: A retrospective chart review compared bidirectional Glenn operation outcomes for children undergoing the Norwood operation with NW-RVPA or NW-BTS at Children’s Hospital Boston from January 1, 2002, to December 31, 2003.

Results: Of 80 patients undergoing the Norwood operation, 56 (NW-BTS, 27 versus NW-RVPA, 29) returned for the bidirectional Glenn operation at our institution. The NW-RVPA group had a lower median age at presentation for bidirectional Glenn (4.5 months versus 5.8 months; p = 0.01), but had better weight gain (20.6 g/day versus 16.5 g/day; p = 0.03) than the NW-BTS group. No interstage deaths occurred in the NW-RVPA group. There were no differences in morbidity or mortality after the BDG between the two groups.

Conclusions: There were no differences in morbidity and mortality outcomes after the bidirectional Glenn operation between the NW-RVPA and NW-BTS groups. Despite younger age at presentation, the NW-RVPA patients had better growth rate, which may have contributed to the similar postoperative outcomes.




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