Outcome of the Glenn procedure as definitive palliation in single ventricle patients

• Published in: International journal of cardiology 2020-03, Vol.303, p.30-35
• Main Authors: Vermaut, Astrid, De Meester, Pieter, Troost, Els, Roggen, Leen, Goossens, Eva, Moons, Philip, Rega, Filip, Meyns, Bart, Gewillig, Marc, Budts, Werner, Van De Bruaene, Alexander
• Format: Article
• Language: English
• Subjects: Belgium - epidemiology; Cavopulmonary shunt; Child, Preschool; Congenital heart defects; Follow-Up Studies; Fontan Procedure - methods; Glenn shunt; Heart Defects, Congenital - mortality; Heart Defects, Congenital - surgery; Heart Ventricles - abnormalities; Heart Ventricles - surgery; Humans; Infant; Palliative Care - methods; Retrospective Studies; Single ventricle circulation; Survival Rate - trends; Time Factors; Treatment Outcome
• ISSN: 0167-5273; 1874-1754
• DOI: 10.1016/j.ijcard.2019.10.031

In selected single ventricle patients, a Glenn procedure (SV-Glenn) may be considered as definitive palliation. Either the patient is unsuited to progress to a Fontan circulation or a SV-Glenn circulation is preferred. This study aimed at describing the clinical course, and long-term mortality/morbidity of SV-Glenn patients. All SV-Glenn patients followed at the University Hospitals Leuven before May 2018 were included. Patients who underwent, or were awaiting, TCPC completion and those who underwent a Glenn in the setting of a biventricular circulation one-and-a-half repair (OAHR), were excluded. Of 65 Glenn-only patients identified, 21 (32%) had OAHR, whereas 44 (68%) were SV-Glenn patients. Of SV-Glenn patients, 19 died within 6 months after the Glenn procedure. Of 25 SV-Glenn survivors, median age at Glenn was 6.3 (IQR 1.2–29.7) years. Eight were unsuited for TCPC completion; in 17 SV-Glenn was preferred over TCPC completion. Over a median follow-up time of 11 (IQR 3–18) years after the Glenn procedure, 5 (20%) patients died. At latest follow-up 10 (40%) had heart failure, 5 (20%) had atrial and 4 (16%) ventricular arrhythmias, 2 (8%) a thromboembolic event, 7 (28%) required pacemaker implantation, and 2 (8%) had infective endocarditis but none developed cirrhosis or protein-losing enteropathy. Mean saturation at latest follow-up was 87 ± 7%. SV-Glenn patients represent a unique and heterogeneous patient population. Outcome was reasonable, although comorbidities, such as heart failure and arrhythmias were not uncommon. In SV-Glenn patients, ‘classic’ complications related to Fontan physiology, such as cirrhosis and protein-losing enteropathy, were absent. •SV-Glenn patients represent a heterogeneous population.•Medium-to-long term mortality is reasonable.•Comorbidities in SV-Glenn patients are not uncommon.•Glenn palliation in adulthood is feasible.