Abstract
Objective. The Glenn procedure is known as the bidirectional cavopulmonary anastomosis and usually tends to be done as an openheart
procedure under cardiopulmonary bypass. In this article we present our preferred technique of performing this operation offpump
and comparative results of the Glenn operation under on-pump technique.
Material and methods. In a retrospective comparative study were included 57 patients who underwent from November 2008 to June
2016 bidirectional Glenn shunt operation. All patients were divided into two groups: group 1 included 34 (59.6%) patients with onpump
technique, group 2 had 23 (40.4%) patients who underwent off-pump. Demographic and clinical characteristics of patients in
both groups were similar for age, weight and pre-operative physiology in general.
The results. Postoperative complications in the early stages have been identified in the group 1 in 12 (35.3%) patients and in the group
2 – in 4 (17.4%) patients. A risk factor for postoperative complications was increased central venous pressure (CVP) more than
14 mm Hg (p=0.021; odds ratio (OR), 2.18). For patients of group 1 statistically significant influence on the development of complications
had a longer time of cardiopulmonary bypass (p=0.04; OR, 1.23). The right ventricle morphology of a single ventricle presented
as a risk factor for patients in both groups (p=0.04; OR 1.25). Such factors influencing death 1 (2.9%) have not been identified.
Conclusions. The patients with single ventricle physiology can be operated with Glenn shunt by the off-pump technique. The negative
impact on the postoperative period, according to our data, have the following factors: increased time cardiopulmonary bypass,
elevated values of CVP and transpulmonary gradient and right ventricular morphology of the single ventricle. The critical advantages
of Glenn operation with off-pump in comparison with the operation Glenn with on-pump are to be revealed. But undoubtedly, in the
case of the absence of indications for the cardiopulmonary bypass the off-pump option simplifies the procedure of the operation.
References
1. Freedom R.M., Nykanen D., Benson L.N. The physiology of
the bidirectional cavopulmonary connection. Ann. Thorac.
Surg. 1998; 66: 664–7.
2. Подзолков В.П., Зеленикин М.М., Юрлов И.А., Черногри-
вов И.Е. Врожденные пороки сердца с одножелудочковой ге-
модинамикой: коррекция путем обхода правых отделов серд-
ца по принципу Фонтена. Вестник Российской Академии
Медицинских Наук. 2005; 1: 8–13 / Podzolkov V.P., Zelenikin
M.M., Yurlov I.A., Chernogrivov I.E. Congenital heart diseases
with ventricular hemodynamics one: correction through the right
heart bypass on the principle of Fontaine. Vestnik Rossiyskoy
Akademii Meditsinskikh Nauk. 2005; 1: 8–13 (in Russ.).
3. Choussat A., Fontan F., Besse P., Vailot F., Chauve A.,
Bricaud H. Selection criteria for Fontan's procedure. In:
Andersson R.S., Shineboume E.A. (Eds). Paediatric cardiology.
Churchill Livingstone; 1977: 559–66.
4. Бокерия Л.А., Ким А.И., Мовсесян Р.Р., Болтабаев И.И., Ту-
манян М.Р., Рогова Т.В. и др. Первый опыт выполнения опе-
рации двунаправленного кавопульмонального анастомоза
без искусственного кровообращения при хирургическом
лечении сложных врожденных пороков сердца. Грудная
и сердечно-сосудистая хирургия. 2006; 6: 4–6 /
Bockeria L.A., Kim A.I., Movsesyan R.R., Boltabaev I.I., Tumanyan
M.R., Rogova T.V. The first experience of the operation
of bidirectional kavopulmonalnogo anastomosis without
cardiopulmonary bypass in the surgical treatment of complex
congenital heart defects. Grudnaya i serdechno-sosudistaya
khirurgiya. 2006; 6: 4–6 (in Russ.).
5. Lamberti J.J., Spicer R.L., Waldman J.D., Grehl T.M., Thomson
D., George L. et al. The bidirectional cavopulmonary
shunt. J. Thorac. Cardiovasc. Surg. 1990; 100: 22–30.
6. Liu J., Lu Y., Chen H., Shi Z., Su Z., Ding W. Bidirectional
Glenn procedure without cardiopulmonary bypass. Ann.
Thorac. Surg. 2004; 77: 1349–52.
7. Luo X., Yan J., Wu Q., Yang K., Xu J., Liu Y. Clinical application
of bidirectional Glenn shunt with off-pump technique.
Asian Cardiovasc. Thorac. Ann. 2004; 12: 103–6.
8. Шаталов К.В., Бродский А.Г., Махалин М.В., Лобачева Г.В.,
Арнаутова И.В. Предикторы исхода лечения детей с пост-
кардиотомной сердечной недостаточностью при примене-
нии метода экстракорпоральной мембранной оксигенации.
Детские болезни сердца и сосудов. 2012; 4: 24–31 /
Shatalov K.V., Brodskiy A.G., Makhalin M.V., Lobacheva G.V.,
Arnautova I.V. Predictors of treatment outcome of children
with postcardiotomy heart failure in the application of methods
of extracorporeal membrane oxygenation. Detskie bolezni
serdtsa i sosudov. 2012; 4: 24–31 (in Russ.).
9. Черногривов И.Е., Черногривов А.Е., Талышева О.Н., Ба-
зылев В.В. Синдром Дауна и результаты радикальной кор-
рекции полной формы атриовентрикулярного канала. Дет-
ские болезни сердца и сосудов. 2014; 3: 26–37 / Chernogrivov
I.E., Chernogrivov A.E., Talysheva O.N., Bazylev V.V.
Down's syndrome and the results of radical correction of complete
atrioventricular canal shapes. Detskie bolezni serdtsa
i sosudov. 2014; 3: 26–37 (in Russ.).
10. Senzaki H., Isoda T., Ishizawa A., Hishi T. Reconsideration criteria
for the Fontan operation. Influence of pulmonary artery
size on postoperative hemodynamics of the Fontan operation.
Circulation. 1994; 89: 1196–202.
11. Kirklin J., Barratt-Boyes B. Cardiac Surgery. New York, New
York: Churchill Livingston, Inc; 4th ed. 2013.
12. Reddy V., McElhinney D., Moore P., Haas G., Hanley F.
Outcomes after bi-directional cavopulmonary shunt in infants
less than 6 months old. J. Am. Coll. Cardiol. 1997; 29:
1365–70.
13. Jaquiss R., Ghanayem N., Hoffman G., Fedderly R., Cava J.,
Mussatto K. et al. Early cavopulmonary anastomosis in very
young infants after the Norwood procedure: impact on oxygenation,
resource utilization, and mortality. J. Thorac.
Cardiovasc. Surg. 2004; 127: 982–9.
14. Guida M., Lo Cascio A., Guida G., De Garate E., Vasquez M.,
Prieto F., Pecchinenda M. Off-pump bidirectional Glenn through
right anterior thoracotomy. Rev. Bras. Cir. Cardiovasc. 2015;
30 (4): 497–500.
15. Zahr R.A., Kirshbom P.M., Kopf G.S., Sainathan S.,
Steele M.M., Elder R.W., Karimi M. Half a century's experience
with the superior cavopulmonary (classic Glenn) Shunt. Ann.
Thorac. Surg. 2016; 101: 177–82.
16. Baue A., Geha A., Hammond G., Laks H., Naunheim K.
Glenn's Thoracic and Cardiovascular Surgery. Stanford,
Connecticut: Appleton and Lange; 1996.
17. Villagra F., Gomez R., Ignacio H.J., Larraya F.G., Moreno L.,
Sar P. The bidirectional cavopulmonary (Glenn) shunt without
cardiopulmonary bypass: a safe and advisable technique. Rev.
Esp. Cardiol. 2000; 53: 1406–9.
18. Rodriguez R.А., Weerasena N., Cornel G. Should the bi-directional
Glenn procedure be better performed through the support
of cardiopulmonary bypass? J. Thorac. Cardiovasc. Surg.
2000; 119: 634–5.
19. Murthy K.S., Coelho R., Naik S.K., Punnoose A., Thomas W.,
Cherian K.M. Novel techniques of bidirectional Glenn shunt
without cardiopulmonary bypass. Ann. Thorac. Surg. 1999;
67: 1771–4.
20. Kogon B.E., Plattner C., Leong T., Simsic J., Kirshbom P.M.,
Kanter K.R. The bidirectional Glenn operation: a risk factor analysis
for morbidity and mortality. J. Thorac. Cardiovasc. Surg.
2008; 136 (5): 1237–42. DOI: 10.1016/j.jtcvs.2008.05.017.
21. Tireli E., Basaran M., Kafali E., Harmandar B., Camei E.,
Dayioglu E., Onursal E. Peri-operative comparison of different
transient external shunt techniques in bidirectional cavo-pulmonary
shunt. Eur. J. Cardiothorac. Surg. 2003; 23: 518–24.
22. Hussaina S.T., Bhana A., Saprab S., Junejac R., Dasd Sh.,
Sharmae S. The bidirectional cavopulmonary (Glenn) shunt
without cardiopulmonary bypass: is it a safe option? Interact.
Cardiovasc. Thorac. Surg. 2007; 6: 77–82.
23. Jahangari M., Keogh B., Shinebourne E., Lincoln C. Should
the bi-directional Glenn procedure be performed through a
thoracotomy without cardiopulmonary bypass? J. Thorac.
Cardiovasc. Surg. 1999; 118: 367–8.
24. Rodriguez R.A., Cornel G., Semelhago L., Splinter W.M.,
Weerasena N.A. Cerebral effects in superior venal caval cannula
obstruction: the role of brain monitoring. Ann. Thorac.
Surg. 1997; 64: 1820–2.
25. Подзолков В.П., Чиаурели М.Р., Зеленикин М.М., Юр-
лов И.А., Ковалев Д.В., Путято Н.А. и др. Операция Фонте-
на: коррекция или паллиатив? Грудная и сердечно-сосуди-
стая хирургия. 2013; 5: 19–23 / Podzolkov V.P.,
Chiaureli M.R., Zelenikin M.M., Yurlov I.A., Kovalev D.V.,
Putyato N.A. Fontan operation: correction or palliation?
Grudnaya i serdechno-sosudistaya khirurgiya. 2013; 5:
19–23 (in Russ.).
