Off-pump Bidirectional Glenn shunt using clamp and sew technique

ABSTRACT

To evaluate the efficacy of performing Bidirectional Glenns [BDG] using "clamp and sew technique". Quasi-experimental study. Armed Institute of Cardiology / National Institute of Heart Diseases, Rawalpindi from 1[st] January 2011 to 31[st] December 2013. All patients subjected to BDG using clamp and sew technique during study period were included. The salient operative steps included. 1] Dissection of superior vena cava, azygous vein and pulmonary arteries 2] Clamping and division of superior vena cava at cardiac end 3] Clamping of ipsilateral branch pulmonary artery and its anastomosis to the divided superior vena cava. Observed variables included oxygen saturations and internal jugular venous pressure before, during and after the procedure, postoperative ventilation requirements, ICU stay, neuro-cognitive assessment, pleural drainage and mortality. A total of 27 patients were included. 85.2% patients had unilateral BDG while 14.8% patients had bilateral BDG. Mean internal jugular venous pressure on clamping superior vena cava was 29.21 +/- 6.13 mmHg [range 19-23 mmHg] and mean clamp time was 14.32 +/- 3.39 minutes with a range of 11-21 minutes. Mean Glenn pressure was 14.29 +/- 2.53 [range 12-18 mmHg]. Mean postoperative Oxygen saturation was 86.07 +/- 2.71% which was significantly increased as compared to preoperative oxygen saturation of 71 +/- 5.16% [p < 0.001]. Mean ICU stay was 70.45 +/- 8.94 hours [38-210 hours]. No neuro-cognitive impairment was observed and there was no 30 day in hospital mortality. Off-pump BDG with clamp and sew technique is a safe procedure in selective patients. It avoids the need for cardiopulmonary bypass and high cost associated with it