A operação de Glenn bidirecional deve ser realizada com ou sem o auxílio de circulação extracorpórea?

Abstract

Objective: To compare patients who underwent the Bidirectional Glenn Operation with and without cardiopulmonary bypass (CPB), analyzing the characteristics and confirming if there is superiority of either of the employed techniques.Method: Between January 2002 and January 2004, 16 patients with complex heart defects were submitted to this operative technique. The mean age of the patients was 19 months and 14 were female. The patients were divided into two groups: Group A with 7 patients (using CPB) and group B with 9 patients (without the use of CPB). Gender, age, mean pulmonary artery pressure (MPAP), CPB time, aortic clamping time, venoatrial shunt, previous operations, time in intensive care unit (ICU), total hospitalization time and immediate complications were all compared between the two groups.Results: The median MPAP was 13 mmHg. In group A the CPB time was 91 ± 47 minutes (57-195 minutes), myocardial ischemia was 25 ± 33 minutes (0-80 minutes). Of these, four patients required intracardiac procedures or enlargement of the pulmonary branches and in three, CPB assistance as ventilatory support was needed. In group B the venoatrial shunt was 21 ± 10 minutes (0-39 minutes). The time to extubation was 9 ± 13 hours with a median of 3 hours (1-43 hours). The ICU stay was 8 ± 12 days with a median of 5 days (1-50 days). Hospitalization was 12 ± 12 days with a median of 7 days (0-50 days). Five patients had been submitted to surgeries previously. Two, one patient from each group, died (12.5%). No neurological complications, pleural or pericardial effusions were observed. No significant differences were evidenced between the two groups in respect to all the variables studied.Conclusion: In spite of the relatively small cohort, this study suggests that the bidirectional Glenn operation can be performed with or without CPB giving similar results in respect to morbidity and mortality. Thus, the operation without CPB can be safely employed when the anatomic findings are appropriate and there is no severe hypoxia.

Factors affecting the outcomes after bidirectional Glenn shunt: two decades of experience from a tertiary referral center

“…Hussain and colleagues reported no mortality rate in 37 patients who had BDG without cardiopulmonary bypass [ 16 ]. Crotti and collaborators evaluated BDG shunt with and without cardiopulmonary bypass and found no difference in the outcomes between both approaches [ 17 ].…”

“…The atrioventricular valve was competent in 102 patients (43.40%), and 6 had severe regurgitation (2.55%). Preoperative saturation was 86% (80-91), and the mean pulmonary artery pressure was 14 (11)(12)(13)(14)(15)(16)(17)(18) mmHg. (Table 1).…”

Operação de Glenn bidirecional sem circulação extracorpórea em portador de justaposição de apêndices atriais à esquerda

“…Thus, several possibilities could be used for treatment, among them: the tunneling the left ventricle into the aorta with a connection between the RV and the PT, the confection of other BT or central shunt from the aorta to the pulmonary arteries, Jatene's operation or even repair with bidirectional Glenn or Fontan-type univentricular physiology [1,2]. OPERATION Median transsternal thoracotomy, opening of the pericardium and external analysis of cardiac structures.…”

Caso 5/2005 - Cavopulmonar total extracardíaco com tubo de pericárdio bovino corrugado sem auxílio de circulação extracorpórea

“…Sacks for the right atrium and the innominate vein were prepared. Total heparization of 4 mg/kg was initiated and a common venous cannula was used for the veno-atrial shunt with ligation and sectioning of the azygos vein, anastomosis of the superior vena cava to the right pulmonary artery was achieved using polydioxanone 6-0 sutures [1]. Similarly, a derivation between the inferior vena cava and the right atrium was established using another venous cannula with a larger diameter.…”