Uncontrolled Antegrade Pulmonary Blood Flow and Delayed Fontan Completion After the Bidirectional Glenn Procedure: Real-World Outcomes in China Tao Zhang,

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Uncontrolled Antegrade Pulmonary Blood Flow and Delayed Fontan Completion After the Bidirectional Glenn Procedure: Real-World Outcomes in China Tao Zhang, MD, Yisheng Shi, MD, Kaihong Wu, MD, Zhongdong Hua, MD, Shoujun Li, MD, Shengshou Hu, MD, Hao Zhang, MD, PhD The Annals of Thoracic Surgery Volume 101, Issue 4, Pages 1530-1538 (April 2016) DOI: 10.1016/j.athoracsur.2015.10.071 Copyright © 2016 The Society of Thoracic Surgeons Terms and Conditions

Fig 1 Estimated Kaplan-Meyer survival curves of the groups, including early mortality, after bidirectional Glenn anastomosis (p = 0.51, Mantel-Cox). The Annals of Thoracic Surgery 2016 101, 1530-1538DOI: (10.1016/j.athoracsur.2015.10.071) Copyright © 2016 The Society of Thoracic Surgeons Terms and Conditions

Fig 2 Dynamic changes in mean pulmonary artery pressures and Nakata indices during follow-up. (A) Mean pulmonary artery pressure; ∗p < 0.01 for group 2 versus group 1. (B) The Nakata index (The post- bidirectional Glenn procedure (BDDG) mean pulmonary artery pressure was obtained from the central venous pressure after extubation. The pre-Fontan mean pulmonary artery pressure and Nakata index were recorded from the last cardiac catheterization). The Annals of Thoracic Surgery 2016 101, 1530-1538DOI: (10.1016/j.athoracsur.2015.10.071) Copyright © 2016 The Society of Thoracic Surgeons Terms and Conditions

Fig 3 Dynamic changes in ejection fraction, systemic ventricular end-diastolic diameter (SVEDD), and the degree of atrioventricular (AV) valve regurgitation during follow-up. (A) Ejection fraction. (B) SVEDD; ∗p = 0.02 for group 1. (C) AV valve regurgitation; ∗p = 0.01 for group 1 (the pre-Glenn, post-Glenn and pre-Fontan data were recorded from the last echocardiographic study before the Glenn procedure, after the Glenn procedure, and before the Fontan completion, respectively). The Annals of Thoracic Surgery 2016 101, 1530-1538DOI: (10.1016/j.athoracsur.2015.10.071) Copyright © 2016 The Society of Thoracic Surgeons Terms and Conditions

Fig 4 Changes in body weight and arterial oxygen saturation during follow-up. (A) Body weight. (B) Arterial oxygen saturation; ∗p < 0.05 for Group DF; ∗∗p < 0.05 for group DF versus group FC. The Annals of Thoracic Surgery 2016 101, 1530-1538DOI: (10.1016/j.athoracsur.2015.10.071) Copyright © 2016 The Society of Thoracic Surgeons Terms and Conditions

Fig 5 Dynamic changes in ejection fraction (EF), systemic ventricular end-diastolic diameter (SVEDD), and the degree of atrioventricular valve regurgitation during follow-up. (A) Ejection fraction. (B) SVEDD. (C) Atrioventricular valve regurgitation; ∗p < 0.05 for group DF, ∗∗p > 0.05 for group FC. The Annals of Thoracic Surgery 2016 101, 1530-1538DOI: (10.1016/j.athoracsur.2015.10.071) Copyright © 2016 The Society of Thoracic Surgeons Terms and Conditions