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Short and long-term outcomes for bidirectional glenn procedure performed with and without cardiopulmonary bypass
Damien J LaPar1, Carlos M Mery, Benjamin B Peeler
1Department of Surgery, Division of Thoracic and Cardiovascular Surgery, University of Virginia Health System, Charlottesville, Virginia 22908, USA.
Insights
Performing the bidirectional Glenn (BDG) procedure off-pump is a safe alternative to using cardiopulmonary bypass (CPB). Outcomes, including mortality and complications, are similar between the two methods for complex congenital heart defects.
Area of Science:
- Pediatric Cardiac Surgery
- Congenital Heart Disease Management
- Surgical Outcomes Research
Background:
- The bidirectional Glenn (BDG) procedure is a key palliative surgery for complex cyanotic congenital heart defects.
- Outcomes of BDG procedures performed without cardiopulmonary bypass (CPB) are not consistently reported.
- This study aims to compare short- and long-term outcomes of BDG with and without CPB.
Purpose of the Study:
- To compare operative mortality and postoperative complications of the BDG procedure performed with and without CPB.
- To evaluate differences in long-term survival between BDG performed with and without CPB.
- To assess the safety and efficacy of an off-pump BDG approach.
Main Methods:
- A retrospective review of 106 patients undergoing BDG from 2001-2010.
- Patients were stratified into groups based on the use of CPB (n=72) or no CPB (n=34).
- Primary outcomes included operative mortality, postoperative complications, and Kaplan-Meier survival analysis.
Main Results:
- No significant differences in operative mortality (0.9% vs 0.0%, p > 0.99) or overall complication rates (18.1% vs 11.8%, p = 0.57) were observed between CPB and non-CPB groups.
- Postoperative length of stay was similar (7.0 days for both groups).
- Long-term survival rates at 1, 3, and 5 years were high and comparable between the CPB and non-CPB groups.
Conclusions:
- The bidirectional Glenn procedure can be safely performed with or without CPB support, showing no significant differences in mortality, morbidity, or resource utilization.
- Both on-pump and off-pump strategies yield high long-term survival rates following BDG.
- Off-pump BDG should be considered a viable and safe alternative for selected patients requiring this palliative procedure.
Background:
The bidirectional Glenn (BDG) procedure is most commonly used as staged palliation for complex cyanotic congenital heart defects. The benefits of a BDG procedure without the use of cardiopulmonary bypass (CPB) remain mixed within reported series. The purpose of this study was to compare short- and long-term outcomes for performance of a BDG procedure with and without the use of CPB.
Methods:
From 2001 to 2010, 106 patients underwent a BDG procedure. Patients were stratified into CPB (n = 72; age = 202 days) and non-CPB (n = 34; age = 182 days) groups. Primary outcomes included operative mortality and postoperative complications as well as differences in long-term Kaplan-Meier survival.
Results:
Median follow-up was 30 months. Preoperative patient characteristics were similar among patients despite the use of CPB. The most frequent indications for a BDG procedure were hypoplastic left heart syndrome (HLHS) (35.8%) and tricuspid atresia (TA) (17.9%). Median perfusion time was 73 minutes for CPB patients. Overall mortality was 0.9% and no deaths occurred among non-CPB patients (0.0% versus 1.4%; p > 0.99). Similarly, no significant differences existed between non-CPB patients and CPB patients with respect to overall complication rates (11.8% versus 18.1%; p = 0.57) or postoperative length of stay (7.0 [5.0-12.0] versus 7.0 [5.0-11.0] days; p = 0.38). Furthermore, 1-, 3-, and 5-year survival was high and similar between groups.
Conclusions:
The BDG procedure can be performed with no significant differences in operative mortality, morbidity, or use of resources, with or without CPB support. Long-term survival after the BDG procedure is high with both strategies. Performance of an off-pump BDG procedure should be considered a safe alternative to the conventional use of CPB for appropriately selected patients.
