Should the Bidirectional Glenn Operation be performed with or without cardiopulmonary bypass

OBJECTIVE: To compare patients who underwent the Bidirectional Glenn Operation with and without cardiopulmonary bypass (CPB), analyzing the characteristics and confirming if there is superiority of either of the employed techniques. METHOD: Between January 2002 and January 2004, 16 patients with complex heart defects were submitted to this operative technique. The mean age of the patients was 19 months and 14 were female. The patients were divided into two groups: Group A with seven patients (using CPB) and group B with 9 patients (without the use of CPB). Gender, age, mean pulmonary artery pressure (MPAP), CPB time, aortic clamping time, venoatrial shunt, previous operations, time in intensive care unit (ICU), total hospitalization time and immediate complications were all compared between the two groups. RESULTS: The median MPAP was 13 mmHg. In group A the CPB time was 91 ± 47 minutes (57-195 minutes), myocardial ischemia was 25 ± 33 minutes (0-80 minutes). Of these four patients required intracardiac procedures or enlargement of the pulmonary branches and in three, CPB assistance as ventilatory support was needed. In group B the venoatrial shunt was 21 ± 10 minutes (0-39 minutes). The time to extubation was 9 ± 13 hours with a median of 3 hours (1-43 hours). The ICU stay was 8 ± 12 days with a median of 5 days (1-50 days). Hospitalization was 12 ± 12 days with a median of 7 days (0-50 days). Five patients had been submitted to surgeries previously. Two, one patient from each group, died (12.5%). No neurological complications, pleural or pericardial effusions were observed. No significant differences were evidenced between the two groups in respect to all the variables studied. CONCLUSION: In spite of the relatively small cohort, this study suggests that the bidirectional Glenn operation can be performed with or without CPB giving similar results in respect to morbidity and mortality. Thus, the operation without CPB can be safely employed when the anatomic findings are appropriate and there is no severe hypoxia.

[1]  U. Croti,et al.  Case 4/2004 , 2004 .

[2]  Z. Su,et al.  Bidirectional Glenn procedure without cardiopulmonary bypass. , 2004, The Annals of thoracic surgery.

[3]  B. Duncan,et al.  Pulmonary arteriovenous malformations after cavopulmonary anastomosis. , 2003, The Annals of thoracic surgery.

[4]  E. Shinebourne,et al.  Should the bidirectional Glenn procedure be performed through a thoracotomy without cardiopulmonary bypass? , 1999, The Journal of thoracic and cardiovascular surgery.

[5]  S. Nicolson,et al.  Modified ultrafiltration reduces postoperative morbidity after cavopulmonary connection. , 1997, The Annals of thoracic surgery.

[6]  R. Spicer,et al.  Bidirectional Glenn. Is accessory pulmonary blood flow good or bad? , 1995, Circulation.

[7]  F. Hanley,et al.  Primary bidirectional superior cavopulmonary shunt in infants between 1 and 4 months of age. , 1995, The Annals of thoracic surgery.

[8]  M. Dick,et al.  Usefulness of the bidirectional Glenn procedure as staged reconstruction for the functional single ventricle. , 1993, The American journal of cardiology.

[9]  R. Spicer,et al.  The bidirectional cavopulmonary shunt. , 1990, The Journal of thoracic and cardiovascular surgery.

[10]  H. Oldham,et al.  Physiological rationale for a bidirectional cavopulmonary shunt. A versatile complement to the Fontan principle. , 1985, The Journal of thoracic and cardiovascular surgery.

[11]  W W GLENN,et al.  FURTHER EXPERIMENTS ON LONG TERM SURVIVORS AFTER CIRCULATORY BYPASS OF THE RIGHT SIDE OF THE HEART. , 1958, Surgery, gynecology & obstetrics.

[12]  M. Cazzaniga,et al.  La operación de Glenn bidireccional en 100 casos con cardiopatías congénitas complejas: factores determinantes del resultado quirúrgico , 2001 .

[13]  C. Carrington,et al.  Circulatory bypass of the right side of the heart. IV. Shunt between superior vena cava and distal right pulmonary artery; report of clinical application. , 1958, The New England journal of medicine.