Bilateral bidirectional Glenn: outcome of off-pump technique.

Autor:	El Midany AAH; Department of Cardiovascular & Thoracic Surgery, Ain-Shams University Hospital, Faculty of Medicine, Cairo, Egypt., Mostafa EA; Department of Cardiovascular & Thoracic Surgery, Ain-Shams University Hospital, Faculty of Medicine, Cairo, Egypt., Mansour SA; Department of Cardiovascular & Thoracic Surgery, Ain-Shams University Hospital, Faculty of Medicine, Cairo, Egypt., Saffan M; Department of Cardiovascular & Thoracic Surgery, Faculty of Medicine, Banha University, Banha, Egypt., Zalat M; Department of Cardiovascular & Thoracic Surgery, Ain-Shams University Hospital, Faculty of Medicine, Cairo, Egypt., El-Sokkary IN; Department of Cardiovascular & Thoracic Surgery, Faculty of Medicine, Al-Azhar University, Cairo, Egypt., M E Aletreby A; Department of Cardiovascular & Thoracic Surgery, Ain-Shams University Hospital, Faculty of Medicine, Cairo, Egypt.
Jazyk:	angličtina
Zdroj:	Interactive cardiovascular and thoracic surgery [Interact Cardiovasc Thorac Surg] 2017 Nov 01; Vol. 25 (5), pp. 745-749.
DOI:	10.1093/icvts/ivx168
Abstrakt:	Objectives: 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. Methods: 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. Results: 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. Conclusions: 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. (© The Author 2017. Published by Oxford University Press on behalf of the European Association for Cardio-Thoracic Surgery. All rights reserved.)
Databáze:	MEDLINE
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