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

^a Department of Cardiothoracic and Vascular Surgery, All India Institute of Medical Sciences, New Delhi, India
^b Department of Pediatrics and Clinical Psychology, All India Institute of Medical Sciences, New Delhi, India
^c Department of Cardiology, All India Institute of Medical Sciences, New Delhi, India
^d Department of Cardiac Anesthesia, All India Institute of Medical Sciences, New Delhi, India
^e Department of Cardiac Radiology, All India Institute of Medical Sciences, New Delhi, India

*Corresponding author. Senior Consultant Cardiothoracic Surgeon, Department of Cardiothoracic Surgery, Max Devki Devi Heart and Vascular Institute, 2 Press Enclave Road, Saket, New Delhi-110017, India. Tel.: +91-9818572151; fax: +91-11-26510050.

E-mail address: anil_bhan{at}hotmail.com (A. Bhan).

Objectives: 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. Methods: 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. Results: 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. Conclusions: 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.

Key Words: Bidirectional cavopulmonary shunt; Off-pump; Neurological injury