A catheter-only, closed-chest alternative to a bidirectional Glenn shunt is a possible means of improving pulmonary blood flow and clinical outcomes for single-ventricle patients, a first-in-human procedure showed. Performed on a 35-year-old woman presenting with dyspnea and worsening cyanosis, creation of a nonsurgical superior cavopulmonary anastomosis brought systemic arterial saturation from 73 percent with inspired oxygen to 82 percent without supplemental oxygen. Average central and branch pulmonary artery pressure increased from 13 to 14 mm Hg. Additionally, her superior vena cava pressure increased from 8 to 14 mm Hg, according to researchers led by Kanishka Ratnayaka, MD, of Rady Children’s Hospital in San Diego, who detailed the procedure in the Aug. 8 issue of the Journal of the American College of Cardiology. Despite the woman’s initial condition, she recovered without any adverse events and could walk without dyspnea the next day. Her oxygen saturation was 85 percent at six months. “In this patient, the percutaneous approach avoided the expected high morbidity of open-heart surgery and cardiopulmonary bypass,” they wrote. “This procedure may provide a viable alternative to one of the foundational open-heart surgeries currently performed to treat single-ventricle congenital heart disease” Their strategy — apparently two decades in the making — uses transcatheter electro-wire perforation to cross unoperated or naïve intact blood vessel walls and stents to connect adjacent large blood vessels. Ratnayaka and colleagues created the patient’s large-vessel anastomosis after having rehearsed each step using contrast-enhanced cardiac CT and a 3D-printed model of her heart. Follow-up imaging confirmed that the bypass was performed without endovascular leak or complications. “In general, adult patients in whom a one-and-a-half ventricle repair is indicated could be considered,” according to the authors, who added that their novel percutaneous therapy might work for children if smaller devices are available. In fact, they are developing that technology. Yet Barry Love, MD, of New York’s Mount Sinai Medical Center, predicted that the transcatheter Glenn procedure won’t have a large effect in the area of congenital heart disease. “Although not diminishing the authors’ work, this technique is unlikely to have applicability much outside the rare, unoperated adult single-ventricle patient. Even if this procedure could be scaled down and done on much younger patients, a 6-month-old patient is a long way from an adult,” Love wrote in an accompanying editorial. “There would also need to be some fundamental advances in stent technology to allow this type of an approach to be used in infants, as somatic growth would quickly outgrow the implanted size of any stent. Although the authors rightly point out that the surgical Glenn is not without complications, many of these complications are due to unfavorable hemodynamics. It is difficult to accept that a young patient in need of a Glenn would be better served with a percutaneous rather than surgical shunt.” Disclosures The study was supported by funds from Rady Children’s Hospital and the NIH. Ratnayaka is an unpaid collaborator with Transmural Systems. Love disclosed honoraria for participating in clinical trials, proctoring, contributing to advisory boards, or oral presentations from Abbott and W.L. Gore.