Peri-operative comparison of different transient external shunt techniques in bidirectional cavo-pulmonary shunt

Tirelı, Emin; Başaran, Murat; Kafali, Eylül; Harmandar, Buğra; Çamcı, Emre; Dayıoğlu, Enver; Onursal, Ertan

doi:10.1016/s1010-7940(03)00012-5

Cited by 23 publications

(25 citation statements)

References 12 publications

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“…[3] Although some advocated this procedure through right thoracotomy, we often prefer median sternotomy which has the advantages of better exposure and rapid institution of CPB in case of emergency. [2,3] Avoidance of CPB and aortic cross clamping has the advantages including earlier extubation, less blood products, reduced necessity and duration of inotropic support. Some authors have demonstrated increased pulmonary vascular resistance and hypoxia after CPB and possible development of aortopulmonary shunts after establishing CPB, leading to prolonged pleural effusions.…”

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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Section: Discussionmentioning

confidence: 99%

Bidirectional cavopulmonary anastomosis without cardiopulmonary bypass

Akyüz¹

2015

Turk Gogus Kalp Dama

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“…It may also lead to eddy currents and subsequent thrombus formation. 6 We have realized that median sternotomy approach for constructing BD Glenn shunt has the advantage of allowing a precise anastomosis being constructed, easy conversion if CPB is required, minimal interference with ventilation, which maintains good oxygen saturation during the procedure. Though there are cardiac surgical units that perform this procedure through right thoracotomy, 5 we preferred a median sternotomy, as our concern was both proper alignment of BD Glenn shunt through thoracotomy route and known hazardous effect of SVC clamping without use of CPB.I.…”

Section: Discussionmentioning

confidence: 99%

“…Though there are cardiac surgical units that perform this procedure through right thoracotomy, 5 we preferred a median sternotomy, as our concern was both proper alignment of BD Glenn shunt through thoracotomy route and known hazardous effect of SVC clamping without use of CPB.I. 6 We feel the decompression of the SVC provides more safety margin and assures sufficient cardiac output, which in turn maintains optimal oxygen saturation.…”

Section: Discussionmentioning

confidence: 99%

“…There was no significant drop in oxygen saturation during the clamp time as has been observed in other studies which have compared the cavo atrial bypass to cavo pulmonary bypass 1. 6 We appreciate that in these studies patients have undergone additional procedures like pulmonary arterioplasty etc. There was significant increase in post operative oxygen saturation in all these patients.…”

Section: Discussionmentioning

confidence: 99%

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Bi-directional glenn shunt under veno-venous bypass—A reality

Raghavendra

Mohanty

Pisharat

et al. 2005

Indian J Thorac Cardiovasc Surg

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“…Since its first description by Glenn 1 this operation has undergone a variety of modifications and is commonly performed using continuous cardiopulmonary bypass (CPB) with satisfactory early and long-term results 2 . Various groups have advocated performing this operation without CPB and have claimed it to be advantageous [3][4][5][6][7][8][9][10][11] . In this report, we discuss the evolution of the techniques of BCPS without CPB and present details of our preferred technique of performing this operation in a reproducible manner.…”

Section: Introductionmentioning

confidence: 99%