[Bidirectional Glenn shunt without cardiopulmonary bypass].

Area of Science:

• Cardiovascular Surgery
• Pediatric Cardiac Surgery
• Congenital Heart Disease

Context:

• The bidirectional Glenn shunt (BDG) is a critical palliative procedure for complex cyanotic congenital heart disease.
• Cardiopulmonary bypass (CPB) is traditionally used for BDG, carrying risks of systemic inflammation, coagulopathy, and organ injury.
• Minimally invasive or alternative techniques are sought to mitigate CPB-related adverse effects.

Purpose:

• To evaluate the feasibility, safety, and efficacy of performing off-pump bidirectional Glenn shunt (BDG) using a temporary bypass technique.
• To assess hemodynamic stability, oxygenation, and surgical outcomes in patients undergoing this modified BDG procedure.
• To determine if this off-pump approach can be a viable alternative to traditional CPB-dependent BDG.

Summary:

• A retrospective review of 18 patients undergoing off-pump BDG with temporary bypass between April 2002 and March 2005.
• Temporary bypass was established between the superior vena cava or innominate vein and the main pulmonary artery or right atrium.
• Hemodynamics and oxygenation remained stable, with no emergent need for CPB. Mean transpulmonary pressure gradients were low post-procedure (6.7 mmHg immediately, 5.6 mmHg at 24 hours). Mild flow turbulence was noted in one case.

Impact:

• This off-pump BDG technique provides a good surgical view and stable hemodynamics, enabling satisfactory outcomes in selected patients.
• It successfully avoids the complications associated with cardiopulmonary bypass, such as lung injury and the need for blood transfusions.
• The findings support the adoption of off-pump BDG, potentially facilitating its combination with more complex surgical procedures.