Bidirectional Glenn shunt without cardiopulmonary bypass

ABSTRACT

To determine the efficacy of bidirectional Glenn shunt [BDG] without cardiopulmonary bypass [CPB]. Quasi experimental study. The Armed Forces Institute of Cardiology and National Institute of Heart Diseases [AFIC- NIHD], Rawalpindi. Thirty one patients underwent BDG without CPB between January 2006 to December 2007. Subjects for off pump BDG were those who did not require any intracardiac repair, had good sized branch pulmonary arteries, had acceptable PA pressures [< 16 mm Hg], and did not have any significant atrio-ventricular [AV] valve regurgitation. The off pump BDG was performed using veno-venous shunt between the superior vena cava [SVC] and right atrium [RA] following heparinization. All patients underwent discharge echocardiography to assess BDG patency. Statistical significance was determined using t-test with statistical significance at p < 0.05. There were 18 males and 13 females. All patients survived. Twenty seven [87.09%] patients received BDG and 04 patients [12.90%] received bilateral BDG. Atrial septectomy with inflow occlusion was performed in 5 patients. Antegrade pulmonary blood flow was left in 24 [77.41%] of 31 patients. There was significant improvement in postoperative SpO[2] [p = 0.000] in all the cases. There were no postoperative neurologic complications. Sepsis occurred in 2 patients who ultimately recovered. One patient had chylothorax which stopped after three [03] days in ICU. No SVC/PA distortions were noted by discharge echocardiography. Eliminating CPB reduced the cost of the procedure substantially and saved the patients from its inherent complications. BDG without CPB is a safe procedure in selected patients. It avoids CPB related problems and is cost effective, with excellent results: