Bidirectional glenn operation without cardiopulmonary bypass: Operative protocol and early results

Abstract

The bidirectional Glenn (BDG) shunt operation serves as temporary treatment of single-ventricle phys-iology before the eventual Fontan procedure. Some cases can be performed without the support of a cardiopulmonary bypass (CPB) machine. In this study, we present the surgical outcomes of off-pump BDG operations with the use of temporary veno-atrial shunt to decompress the superior vena cava (SVC) during clamping. From June 2013 to June 2015, 23 patients underwent off-pump BDG opera-tions at Cardiovascular Center, E Hospital. All patients were operated on using a venoatrial shunt to decompress the SVC. Satisfactory results with mean oxygen saturation increased from 79.6 ± 11.2 % to 87.2 ± 4.7 %. The superior vena cava (SVC) clamping time was 14 ± 2.4 minutes (ranging from 12 to 21 minutes). No neurological complications or deaths occurred after the surgery and the postop-erative period was uneventful. In conclusion, the use of venoatrial shunt to decompress SVC during the off-pump BDG operation is safe and produces good surgical outcomes. Its wider adoption can the deleterious effects associated with CPB. The operation is easily reproducible at low cost and overcome.