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The bidirectional cavopulmonary (Glenn) shunt without cardiopulmonary bypass: is it a safe option?
Syed Tarique Hussain1, Anil Bhan, Savita Sapra
1Department of Cardiothoracic and Vascular Surgery, All India Institute of Medical Sciences, New Delhi, India.
Insights
This study demonstrates that the bidirectional Glenn shunt can be safely performed without cardiopulmonary bypass in select pediatric patients. This approach avoids bypass complications and is cost-effective, yielding excellent outcomes for cyanotic congenital heart disease.
Area of Science:
- Pediatric Cardiac Surgery
- Congenital Heart Disease Management
- Cardiovascular Surgery Innovations
Background:
- The bidirectional Glenn (cavopulmonary) shunt is crucial for single ventricle repair in cyanotic congenital heart defects.
- Conventional Glenn procedures often utilize cardiopulmonary bypass, incurring associated risks and costs.
Purpose of the Study:
- To evaluate the safety and efficacy of performing the bidirectional Glenn operation without cardiopulmonary bypass.
- To assess the feasibility of this modified technique in a pediatric cohort.
Main Methods:
- 37 patients with complex cyanotic congenital heart defects underwent the procedure, with 22 performed off-pump.
- Temporary superior vena cava clamping was employed; neurological and developmental assessments were conducted pre- and post-operatively.
Main Results:
- No operative mortality was observed.
- Mean follow-up was over 17 months with no neurological complications or developmental decline.
- Hemodynamic stability and adequate oxygen saturation were maintained throughout the off-pump procedures.
Conclusions:
- The bidirectional Glenn operation without cardiopulmonary bypass is a safe and economical alternative for selected pediatric patients.
- This technique effectively mitigates the adverse effects associated with cardiopulmonary bypass.
Objectives:
The bidirectional cavopulmonary (Glenn) shunt is a commonly performed procedure for a variety of cyanotic congenital heart diseases that lead eventually to a single ventricle repair. It is usually performed under cardiopulmonary bypass with its associated adverse effects and costs. We report our results of bidirectional Glenn operation done without cardiopulmonary bypass.
Methods:
Between January 2002 and July 2003, 37 patients with complex cyanotic congenital heart defects underwent bidirectional Glenn operation by a single surgeon at our center. Of these, 22 patients had the procedure performed without cardiopulmonary bypass. Age of the patients ranged from 7 months to 11 years (mean 3.11+/-2.38 years). The procedures were done with temporary clamping of the superior vena cava. Four patients had bilateral Glenn procedure done and one had additional right pulmonary artery-plasty done. All the patients underwent complete neurological examination, CT scan of head and developmental quotient/intelligence quotient test both preoperatively as well as postoperatively.
Results:
There was no operative mortality in our patients. Mean follow-up was 17.18+/-5.28 months. The mean internal jugular venous pressure on clamping the superior vena cava was 34.04+/-10.15 mmHg, and the mean clamp time was 6.85+/-1.52 min. There was no hemodynamic instability during any of the procedures and oxygen saturation was maintained at more than 65-70% throughout the procedure. The mean intensive care unit stay was 1.27+/-0.45 days. There were no neurological complications in any patient as assessed clinically and by CT scan of the head. None of the patients showed deterioration of developmental quotient/intelligence quotient score during follow-up evaluation.
Conclusions:
Our results show that in selected patients, bidirectional Glenn operation without cardiopulmonary bypass is a safe procedure. It avoids cardiopulmonary bypass related problems and is economical, with excellent results.
