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Original research
Comparison of definitive approaches for conotruncal defects following bidirectional Glenn procedure
  1. Yuze Liu,
  2. Qiyu He,
  3. Zheng Dou,
  4. Kai Ma,
  5. Xinjie Lin,
  6. Shoujun Li
  1. Pediatric Cardiac Surgery Center, Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
  1. Correspondence to Professor Shoujun Li, Pediatric Cardiac Surgery Center, Chinese Academy of Medical Sciences & Peking Union Medical College Fuwai Hospital, Xicheng District, Beijing, China; drlishoujunfw{at}


Background Staged repair is common for complex conotruncal defects, often involving bidirectional Glenn (BDG) procedure. Following the cavopulmonary shunt, both Fontan completion and biventricular conversion (BiVC) serve as definitive approaches. The optimal strategy remains controversial.

Methods The baseline, perioperative and follow-up data were obtained for all paediatric patients with conotruncal defects who underwent BDG procedure as palliation in Fuwai Hospital from 2013 to 2022. Patients with single ventricle were excluded. The primary outcome was mortality. The secondary outcome was reintervention, including any cardiovascular surgeries and non-diagnostic catheterisations.

Results A total of 232 patients were included in the cohort, with 142 underwent Fontan (61.2%) and 90 underwent BiVC (38.8%). The median interstage period from BDG to the definitive procedure was 3.83 years (IQR: 2.72–5.42) in the overall cohort, 3.62 years (IQR: 2.57–5.15) in the Fontan group and 4.15 years (IQR: 3.05–6.13) in the BiVC group (p=0.03). The in-hospital outcomes favoured the Fontan group, including duration of cardiopulmonary bypass, aortic cross-clamp, mechanical ventilation and intensive care unit stay. Postoperative mortality was generally low and comparable, as was the reintervention rate (HR=1.42, 95% CI: 0.708 to 2.85, p=0.32). The left ventricular size was smaller at baseline and within the normal range at follow-up for both Fontan and BiVC groups; however, it was significantly larger with BiVC at follow-up.

Conclusion In paediatric patients with conotruncal heart defects who underwent BDG procedure, BiVC is a feasible option, especially for patients with certain Fontan risk factors, and are not ideal candidates for successful Fontan completion.

  • Heart Defects, Congenital
  • Fontan Procedure
  • Cardiac Surgical Procedures

Data availability statement

Data are available upon reasonable request. The data used in this study could be obtained by reasonable request to the corresponding author.

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Data availability statement

Data are available upon reasonable request. The data used in this study could be obtained by reasonable request to the corresponding author.

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  • YL and QH are joint first authors.

  • YL and QH contributed equally.

  • Contributors YL and QH: conceptualisation, data processing, manuscript writing, and revising. ZD, KM, and XL: investigation. SL: conceptualisation, supervision, and acting as the guarantor of this work.

  • Funding This study was supported by Capital Health Research and Development of Special Fund (2022-1-4032) and the National High Level Hospital Clinical Research Funding (2022-GSP-GG-19).

  • Competing interests None declared.

  • Patient and public involvement Patients and/or the public were involved in the design, or conduct, or reporting, or dissemination plans of this research. Refer to the Methods section for further details.

  • Provenance and peer review Not commissioned; externally peer reviewed.