Mainwaring R D, Lamberti J J, Uzark K, Spicer R L, Cocalis M W, Moore J W
Cardiac Institute, Children's Hospital-San Diego, San Diego, CA, USA.
Circulation. 1999 Nov 9;100(19 Suppl):II151-6. doi: 10.1161/01.cir.100.suppl_2.ii-151.
The bidirectional Glenn procedure (BDG) is used in the staged surgical management of patients with a functional single ventricle. Controversy exists regarding whether accessory pulmonary blood flow (APBF) should be left at the time of BDG to augment systemic saturation or be eliminated to reduce volume load of the ventricle. The present study was a retrospective review of patients undergoing BDG that was conducted to assess the influence of APBF on survival rates.
From 1986 through 1998, 149 patients have undergone BDG at our institution. Ninety-three patients had elimination of all sources of APBF, whereas 56 patients had either a shunt or a patent right ventricular outflow tract intentionally left in place to augment the pulmonary blood flow provided by the BDG. The operative mortality rate was 2.2% without APBF and 5.4% with APBF. The late mortality rate was 4.4% without APBF and 15.1% with APBF. Actuarial analysis demonstrates a divergence of the Kaplan-Meier curves in favor of patients in whom APBF was eliminated (P<0.02). One hundred seven patients have subsequently undergone completion of their Fontan operation, so the actuarial analysis includes the operative risk of this second operation.
The results suggest that the elimination of APBF at the time of BDG may confer a long-term advantage for patients with a functional single ventricle.
双向格林手术（BDG）用于功能性单心室患者的分期手术治疗。关于在BDG手术时是否应保留肺副血流（APBF）以提高体循环血氧饱和度，还是应消除以减轻心室容量负荷，存在争议。本研究是对接受BDG手术的患者进行的回顾性分析，旨在评估APBF对生存率的影响。
1986年至1998年，我院共有149例患者接受了BDG手术。93例患者消除了所有APBF来源，而56例患者有意保留分流或右心室流出道通畅，以增加BDG提供的肺血流量。无APBF患者的手术死亡率为2.2%，有APBF患者为5.4%。无APBF患者的晚期死亡率为4.4%，有APBF患者为15.1%。生存分析显示，Kaplan-Meier曲线呈分化趋势，有利于消除APBF的患者（P<0.02）。随后，107例患者完成了Fontan手术，因此生存分析包括了第二次手术的手术风险。
结果表明，BDG手术时消除APBF可能对功能性单心室患者具有长期益处。
