The bidirectional cavopulmonary (Glenn) shunt without cardiopulmonary bypass: is it a safe option?

Abstract

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. 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. 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. 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.