El Midany Ashraf A H, Mostafa Ezzeldin A, Mansour Sherif A, Saffan Mohammed, Zalat Mahmoud, El-Sokkary Ismail N, M E Aletreby Ahmed
Department of Cardiovascular & Thoracic Surgery, Ain-Shams University Hospital, Faculty of Medicine, Cairo, Egypt.
Department of Cardiovascular & Thoracic Surgery, Faculty of Medicine, Banha University, Banha, Egypt.
Interact Cardiovasc Thorac Surg. 2017 Nov 1;25(5):745-749. doi: 10.1093/icvts/ivx168.
Off-pump bilateral bidirectional Glenn (b-BDG) poses a surgical challenge and may add complexity to the postoperative outcome especially regarding uniformity of the anastomosis and central pulmonary artery growth. Herein, we report early- and mid-term outcomes after off-pump b-BDG without using superior vena cava decompression techniques.
Ninety-seven consecutive patients, between 2009 and 2014, were included in this prospective study. All patients had complete pre- and postoperative clinical and detailed neurological assessments. Diagnosis and follow-up were done by echocardiography and cardiac catheterization for assessment of pulmonary artery anatomically and haemodynamically. Median follow-up period was 3.5 years. Perioperative variables, clinical outcome, morbidity, mortality and follow-up data were recorded.
Hypoplastic right ventricle was present in 52 cases (53.6%) and hypoplastic left ventricle was present in 45 cases (46.4%). Mean superior vena cava pressure on clamping was 21.49 ± 3.04 mmHg. Mean total clamping time was 23.11 ± 3.44 min. Mean oxygen saturation increased from preoperative 69.22 ± 6.01% to 83.66 ± 3.97% after b-BDG construction (P-value ≤ 0.0001). The Nakata index increased from 288.47 ± 28.66 mm2/m2 to 303.64 ± 26.85mm2/m2 on follow-up (P-value ≤ 0.05). In-hospital mortality was 4 patients (4.1%) due to low-cardiac output. There were chylothorax in 9 patients (9.3%) and convulsions in 4 patients (4.1%) who were treated conservatively.
Off-pump b-BDG can be conducted safely, with a uniform anastomosis that allows a good central pulmonary artery growth for subsequent Fontan completion. Moreover, avoiding the use of cardiopulmonary bypass is more economic and less hazardous.
非体外循环下双侧双向格林分流术（b-BDG）是一项外科挑战，可能会增加术后结果的复杂性，尤其是在吻合口的均匀性和中心肺动脉生长方面。在此，我们报告了在不使用上腔静脉减压技术的情况下非体外循环b-BDG术后的早期和中期结果。
本前瞻性研究纳入了2009年至2014年间连续的97例患者。所有患者术前和术后均进行了完整的临床及详细的神经学评估。通过超声心动图和心导管检查进行诊断和随访，以从解剖学和血流动力学方面评估肺动脉。中位随访期为3.5年。记录围手术期变量、临床结果、发病率、死亡率和随访数据。
52例（53.6%）存在右心室发育不良，45例（46.4%）存在左心室发育不良。夹闭时平均上腔静脉压力为21.49±3.04mmHg。平均总夹闭时间为23.11±3.44分钟。b-BDG构建后，平均血氧饱和度从术前的69.22±6.01%提高到83.66±3.9
