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

Hussain, Syed T.; Bhan, Anil; Sapra, Savita; Juneja, Rajnish; Das, Shambhu; Sharma, Sanjeev

doi:10.1510/icvts.2006.133710

Cited by 33 publications

(49 citation statements)

References 12 publications

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“…There is one report 7 of decompression by aspirating the SVC with a syringe. It seems to be reasonable to use a shunt though our report and the reports by Jahangiri 4 and Hussain 14 show that it is by no means mandatory.…”

Section: Discussionmentioning

confidence: 51%

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Off pump bidirectional Glenn performed through a thoracotomy

Dixit

Gan

Dubey

et al. 2007

Indian J Thorac Cardiovasc Surg

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Introduction:The bidirectional Glenn shunt has become an accepted method of palliation for single ventricle physiology and an intermediate step prior to the Fontan type operations. Attempts have been made to perform this operation without the use of cardiopulmonary bypass thereby eliminating its deleterious effects. The aim of this study was to review our experience with bidirectional Glenn shunt performed via thoracotomy without cardiopulmonary bypass.Methods: Aretrospective review of fifteen patients (11 males) with ages ranging from 30 to 120 months (mean 44±5.2 months) who underwent off pump bidirectional glenn via thoracotomy.Results: There were two deaths in the study patients due to septicemia and acute renal failure. None of the patients had any seizure or focal or global neurologic deficit. All patients who were discharged had a patent Glenn shunt on echocardiography.Conclusion: Off pump bi-directional Glenn can be safely performed by an experienced surgeon in selected patients. The thoracotomy approach in properly selected patients gives good exposure and would reduce adhesions during future Fontan operation. (Ind J Thorac Cardiovasc Surg, 2007; 23: 180-183)

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Section: Discussionmentioning

confidence: 51%

“…Leaving the azygous vein open during the construction of the anastomosis has been put forward as an internal shunt 14 . Others believe that since the azygous vein is valved, its role in decompressing the SVC is doubtful.…”

Section: Discussionmentioning

confidence: 99%

Off pump bidirectional Glenn performed through a thoracotomy

Dixit

Gan

Dubey

et al. 2007

Indian J Thorac Cardiovasc Surg

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“…[11] Although such reports have documented no significant differences in neurological sequelae after clamping the SVC without the use of any shunt, we believe that clamping the SVC without a temporary shunt may lead to decreased cerebral blood flow and put the brain at risk. [12,13] In a study, Liu et al [13] reported that BCPA without CPB was reasonably safe, if SVC pressure after clamping remained at less than 30 mmHg and clamping time was less than 30 minutes. In consistent with these findings, the mean SVC clamping time and SVC pressure after clamping remained at less than 30 minutes and 30 mmHg, respectively, without any neurological complications in our study cohort.…”

Section: Discussionmentioning

confidence: 99%

Bidirectional cavopulmonary anastomosis without cardiopulmonary bypass

Akyüz¹

2015

Turk Gogus Kalp Dama

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ÖZAmaç: Bu çalışmada bidireksiyonel kavopulmoner anastomoz oluşturmak için atan kalpte kavoatriyal şant tekniği-nin sonuçları sunuldu. Ça lış ma pla nı: Nisan 2003 -Kasım 2012 tarihleri arasında tek ventrikül kalp fizyolojisi olan 38 ardışık hastaya (18 erkek, 20 kız; ort. yaş 14.9±16.8 ay; dağılım 4 ay -2.5 yıl) atan kalpte bidireksiyonel kavopulmoner anastomoz uygulandı. Ameliyat sırasında ortalama vücut ağırlığı 8.3±3.6 kg idi. Ameliyat öncesi ortalama oksijen satü-rasyonu ve pulmoner arter basıncı sırasıyla %70.7±9.4 ve 14.0±3.8 mmHg idi. Bul gu lar: Ameliyata bağlı mortalite görülmedi. Ortalama vena kava superior klemp zamanı ve klemp sırasında vena kava basıncı sırasıyla 24.3±4.7 dakika ve 26.9±5.5 mmHg idi. Ameliyat sonrası nörolojik komplikasyon veya ritim bozuklukları görülmedi. Ameliyat sonrası oksijen satü-rasyonu %85.9±5.9 idi. Ameliyat sonrası dört hasta kaybedildi. Ortalama yoğun bakım ünitesinde kalış süresi iki gün idi. Takip ekokardiyografisinde herhangi bir tıkanık-lık olmaksızın, fonksiyonel bidireksiyonel kavopulmoner anastomoz izlendi. So nuç: Kavoatriyal şant desteği ile kardiyopulmoner baypas kullanılmadan bidireksiyonel kavopulmoner anastomozu uygulanabilir ve güvenli bir yöntemdir. Ayrıca, kardiyopulmoner baypasın olumsuz etkilerini de ortadan kaldırır.Anah tar söz cük ler: Kardiyopulmoner baypas; bidireksiyonel kavopulmoner anastomoz; tek ventrikül. ABSTRACT Background:In this article, we present the results of an offpump cavoatrial shunt technique to creat a cavopulmonary bidirectional anastomosis. Methods: Thirty-eight consecutive patients (18 boys, 20 girls; mean age 14.9±16.8 months; range 4 months to 2.5 years) with univentricular heart physiology underwent an off-pump cavopulmonary bidirectional anastomosis between April 2003 and November 2012. The mean weight during surgery was 8.3±3.6 kg. The mean preoperative oxygen saturation and pulmonary artery pressure were 70.7±9.4% and 14.0±3.8 mmHg, respectively. Results: There was no surgery-related mortality. The mean superior vena cava clamping time and the mean vena cava pressure during clamping were 24.3±4.7 minutes and 26.9±5.5 mmHg, respectively. There were no postoperative neurological complications or dysrhythmias. The mean postoperative saturation was 85.9±5.9%. There were four postoperative deaths. The mean length of intensive care unit stay was two days. Follow-up echocardiography showed functioning cavopulmonary bidirectional anastomosis without any obstruction. Conclusion: The cavopulmonary bidirectional anastomosis without cardiopulmonary bypass with the support of a cavoatrial shunt is a feasible and safe method. It also eliminates the adverse effects of cardiopulmonary bypass.

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“…It can be performed with or without cardio-pulmonary bypass as far as the pulmonary perfusion is maintained. [1,2] During the procedure, the superior vena cava (SVC) is clamped and the proximal pressures can rise as high as 40 to 55 mmHg. This impairs blood flow to the brain (Cerebral perfusion pressure = Mean arterial pressure -Central venous pressure).…”

Section: Introductionmentioning

confidence: 99%

Decompression of superior vena cava during bidirectional Glenn shunt

et al. 2009

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Patients undergoing bi-directional Glenn shunt for various congenital anomalies of the heart will have their superior vena cava (SVC) clamped during the procedure. The duration of the procedure is variable, ranging from five to 30 minutes. This can affect the cerebral perfusion due to raised venous pressure [Cerebral blood flow = Mean arterial pressure-(Intracranial pressure + Central venous pressure)]. Shunting away the SVC blood is a well known technique to counter this problem, but we describe two cases where a novel technique was successfully used to decompress the SVC.

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

Abstract: 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.

Cited by 33 publications

References 12 publications

Off pump bidirectional Glenn performed through a thoracotomy

Off pump bidirectional Glenn performed through a thoracotomy

Bidirectional cavopulmonary anastomosis without cardiopulmonary bypass

Decompression of superior vena cava during bidirectional Glenn shunt

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