Bilateral bidirectional Glenn: outcome of off-pump technique

Area of Science:

• Cardiovascular Surgery
• Pediatric Cardiology
• Congenital Heart Disease

Background:

• Off-pump bilateral bidirectional Glenn (b-BDG) surgery presents surgical challenges, particularly in achieving uniform anastomosis and promoting central pulmonary artery growth.
• Postoperative outcomes can be complex, necessitating evaluation of alternative surgical techniques.

Purpose of the Study:

• To evaluate the early- and mid-term outcomes of off-pump b-BDG procedures conducted without superior vena cava decompression.
• To assess the safety, efficacy, and impact on pulmonary artery development of this surgical approach.

Main Methods:

• A prospective study included 97 consecutive patients undergoing off-pump b-BDG between 2009 and 2014.
• Pre- and postoperative clinical and neurological assessments, echocardiography, and cardiac catheterization were performed.
• Follow-up data, including perioperative variables, clinical outcomes, morbidity, and mortality, were meticulously recorded over a median of 3.5 years.

Main Results:

• Mean oxygen saturation significantly increased from 69.22% preoperatively to 83.66% postoperatively (P≤0.0001).
• The Nakata index, indicating pulmonary artery size, improved from 288.47 mm²/m² to 303.64 mm²/m² (P≤0.05).
• In-hospital mortality was 4.1%, with complications including chylothorax (9.3%) and convulsions (4.1%), all managed conservatively.

Conclusions:

• Off-pump b-BDG can be safely performed, yielding uniform anastomoses and promoting adequate central pulmonary artery growth for subsequent Fontan completion.
• Eliminating cardiopulmonary bypass offers economic advantages and reduces surgical hazards.