Impact of bilateral superior venae cavae on outcome of staged Fontan procedure.

Abstract

The presence of bilateral superior venae cavae may add complexity to the performance of a bidirectional Glenn procedure (BDG). Stagnation of blood flow between the two cavopulmonary anastomoses may increase the risk of thrombosis and impair central pulmonary artery growth. Forty patients underwent BDG from January 2004 to April 2011. The cohort was divided into two groups: those receiving bilateral BDG (b-BDG, n = 13) and those receiving unilateral BDG (u-BDG, n = 27). Operative, angiographic, and follow-up data were analyzed retrospectively. None of the patients experienced thrombosis. There was no difference in actuarial survival rate (u-BDG vs b-BDG, 100% vs 92% at 5 years, p = 0.15). On follow-up angiography, no difference in central pulmonary artery index was noted (78.4 ± 45.5 vs 60.4 ± 32.1, p = 0.24). Central pulmonary artery stenosis was detected in 6 patients (4 with u-BDG and 2 with b-BDG), 4 of whom (2 from each group) underwent balloon pulmonary artery plasty before the Fontan procedure. There was no difference in freedom from reintervention for central pulmonary artery stenosis (93% vs 85% at 1 year, p = 0.59). The rate of Fontan completion was comparable between groups, with similar operative variables and satisfactory outcomes. Bilateral BDG did not increase the risks of thrombosis and central pulmonary artery hypoplasia and can be performed safely without altering the outcome of the Fontan procedure.