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Results with continuous cardiopulmonary bypass for the bidirectional cavopulmonary anastomosis*

Published online by Cambridge University Press:  07 March 2008

Robroy H. MacIver ,
Robert D. Stewart ,
Carl L. Backer  and
Constantine Mavroudis
Robroy H. MacIver
Affiliation:
Division of Cardiovascular-Thoracic Surgery, Children’s Memorial Hospital, Northwestern University Feinberg School of Medicine, Chicago, Illinois, United States of America
Robert D. Stewart
Affiliation:
Division of Cardiovascular-Thoracic Surgery, Children’s Memorial Hospital, Northwestern University Feinberg School of Medicine, Chicago, Illinois, United States of America
Carl L. Backer
Affiliation:
Division of Cardiovascular-Thoracic Surgery, Children’s Memorial Hospital, Northwestern University Feinberg School of Medicine, Chicago, Illinois, United States of America
Constantine Mavroudis*
Affiliation:
Division of Cardiovascular-Thoracic Surgery, Children’s Memorial Hospital, Northwestern University Feinberg School of Medicine, Chicago, Illinois, United States of America
*
Division of Cardiovascular-Thoracic Surgery – MC22, Children’s Memorial Hospital, 2300 Children’s Plaza, Chicago, IL, USA. Tel: (773) 880 4378; Fax: 773 880 3054; E-mail: [email protected]
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Abstract

Objective

Some centres have proposed creating the bidirectional cavopulmonary anastomosis without cardiopulmonary bypass, while others continue to use deep hypothermic circulatory arrest. The purpose of this review is to evaluate the results of using continuous cardiopulmonary bypass with moderate hypothermia, perhaps the most commonly used of the three techniques for this procedure.

Methods

Between 1990 and 2005, 114 patients, having a mean age of 1.58 years, with a median age of 8 months, and ranging from 3 months to 16 years, underwent creation of either a unilateral cavopulmonary anastomosis, in 94 cases, or bilateral anastomoses in 20 cases. All had continuous cardiopulmonary bypass with moderate hypothermia at 32 degrees Celsius, with 24 also having aortic cross-clamping with cardioplegia for simultaneous intracardiac procedures. Interrupted absorbable sutures were used to create the anastomosis in 105 patients.

Results

Perioperative mortality was 5%, with 6 of the patients dying. The mean period of cardiopulmonary bypass for an isolated anastomosis was 91 minutes, with a range from 44 to 160 minutes. In 10 patients (8.8%), it was necessary to place a graft to augment the anastomosis. The average postoperative length of stay was 7.9 days for those undergoing an isolated unilateral anastomosis, and 16.4 days for patients undergoing combined cardiac operations. We have now created the Fontan circulation in 79 of the patients, at an average interval from the bidirectional cavopulmonary anastomosis of 2.1 plus or minus 1.14 years. In 76 patients, we performed postoperative angiograms, and none revealed any stenoses.

Conclusions

The bidirectional cavopulmonary anastomosis can be performed successfully with continuous cardiopulmonary bypass and moderate hypothermia with a beating heart, avoiding circulatory arrest. The use of interrupted and absorbable sutures was not associated with any late anastomotic stenosis.

Keywords

Congenital heart diseasebidirectional Glenninterrupted anastomosis
Type
Original Article
Information
Cardiology in the Young , Volume 18 , Issue 2 , April 2008 , pp. 147 - 152
Copyright
Copyright © Cambridge University Press 2008

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Footnotes

*

The presentation on which this work is based was given at the Inaugural Meeting of the World Society for Pediatric and Congenital Heart Surgery, held in Washington, District of Columbia, May 3 and 4, 2007.

References

1. Karl, TR, Stellin, G. Early Italian contributions to cavopulmonary shunt surgery. Ann Thorac Surg 1999; 67: 1175.Google ScholarPubMed
2. Glenn, WW. Circulatory bypass of the right side of the heart. IV. Shunt between superior vena cava and distal right pulmonary artery; report of clinical application. N Engl J Med 1958; 259: 117–120.CrossRefGoogle ScholarPubMed
3. Glenn, WWL, Ordway, NK, Talner, NS, Call, EP Jr. Circulatory bypass of the right side of the heart. VI. Shunt between superior vena cava and distal right pulmonary artery; report of clinical application in thirty-eight cases. Circulation 1965; 31: 172–189.CrossRefGoogle ScholarPubMed
4. Mavroudis, C, Backer, CL, Kohr, LM, et al. Bidirectional Glenn shunt in association with congenital heart repairs: the 1(1/2) ventricular repair. Ann Thorac Surg 1999; 68: 976–982.CrossRefGoogle ScholarPubMed
5. Norwood, WI, Jacobs, ML. Fontan’s procedure in two stages. Am J Surg 1993; 166: 548–551.CrossRefGoogle ScholarPubMed
6. Konstantinov, IE, Alexi-Meskishvili, VV. Cavo-pulmonary shunt: from the first experiments to clinical practice. Ann Thorac Surg 1999; 68: 1100–1106.CrossRefGoogle ScholarPubMed
7. Liu, J, Lu, Y, Chen, H, Shi, Z, Su, Z, Ding, W. Bidirectional Glenn procedure without cardiopulmonary bypass. Ann Thorac Surg 2004; 77: 1349–1352.CrossRefGoogle ScholarPubMed
8. Luo, XJ, Yan, J, Wu, QY, Yang, KM, Xu, JP, Liu, YL. Clinical application of bidirectional Glenn shunt with off-pump technique. Asian Cardiovasc Thorac Ann 2004; 12: 103–106.CrossRefGoogle ScholarPubMed
9. Lamberti, JJ, Spicer, RL, Waldman, JD, et al. The bidirectional cavopulmonary shunt. J Thorac Cardiovasc Surg 1990; 100: 22–30.CrossRefGoogle ScholarPubMed
10. Hussain, ST, Bhan, A, Sapra, S, Juneja, R, Das, S, Sharma, S. The bidirectional cavopulmonary (Glenn) shunt without cardiopulmonary bypass: is it a safe option? Interact Cardiovasc Thorac Surg 2006; 6: 77–82.CrossRefGoogle ScholarPubMed
11. Tireli, E, Basaran, M, Kafali, E, et al. Peri-operative comparison of different transient external shunt techniques in bidirectional cavo-pulmonary shunt. Eur J Cardiothorac Surg 2003; 23: 518–524.CrossRefGoogle ScholarPubMed
12. Tchervenkov, CI, Jacobs, ML, Del Duca, D. Surgery for the functionally univentricular heart in patients with visceral heterotaxy. Cardiol Young 2006; 16 (Suppl 1): 72–79.CrossRefGoogle ScholarPubMed
13. Caputo, M, Bays, S, Rogers, CA, et al. Randomized comparison between normothermic and hypothermic cardiopulmonary bypass in pediatric open-heart surgery. Ann Thorac Surg 2005; 80: 982–988.CrossRefGoogle ScholarPubMed
14. Majnemer, A, Limperopoulos, C, Shevell, M, Rosenblatt, B, Rohlicek, C, Tchervenkov, C. Long-term neuromotor outcome at school entry of infants with congenital heart defects requiring open-heart surgery. J Pediatr 2006; 148: 72–77.CrossRefGoogle ScholarPubMed
15. Clancy, RR, McGaurn, SA, Wernovsky, G, et al. Risk of seizures in survivors of newborn heart surgery using deep hypothermic circulatory arrest. Pediatrics 2003; 111: 592–601.CrossRefGoogle ScholarPubMed
16. Jahangiri, M, Keogh, B, Shinebourne, EA, Lincoln, C. Should the bidirectional Glenn procedure be performed through a thoracotomy without cardiopulmonary bypass? J Thorac Cardiovasc Surg 1999; 118: 367–368.CrossRefGoogle ScholarPubMed
17. Rodriguez, RA, Cornel, G, Semelhago, L, Splinter, WM, Weerasena, NA. Cerebral effects in superior vena caval cannula obstruction: the role of brain monitoring. Ann Thorac Surg 1997; 64: 1820–1822.CrossRefGoogle ScholarPubMed
18. Rodriguez, RA, Weerasena, NA, Cornel, G. Should the bidirectional Glenn procedure be better performed through the support of cardiopulmonary bypass? J Thorac Cardiovasc Surg 2000; 119: 634–635.CrossRefGoogle ScholarPubMed
19. Masuda, H, Ogata, T, Kikuchi, K. Physiological changes during temporary occlusion of the superior vena cava in cynomolgus monkeys. Ann Thorac Surg 1989; 47: 890–896.CrossRefGoogle ScholarPubMed
20. Chen, YX, Chen, LE, Seaber, AV, Urbaniak, JR. Comparison of continuous and interrupted suture techniques in microvascular anastomosis. J Hand Surg 2001; 26: 530–539.CrossRefGoogle ScholarPubMed
21. Baumgartner, N, Dobrin, PB, Morasch, M, Dong, QS, Mrkvicka, R. Influence of suture technique and suture material selection on the mechanics of end-to-end and end-to-side anastomoses. J Thorac Cardiovasc Surg 1996; 111: 1063–1072.CrossRefGoogle ScholarPubMed
22. Schlechter, B, Guyuron, B. A comparison of different suture techniques for microvascular anastomosis. Ann Plast Surg 1994; 33: 28–31.CrossRefGoogle ScholarPubMed
23. Tiwari, A, Cheng, KS, Salacinski, H, Hamilton, G, Seifalian, AM. Improving the patency of vascular bypass grafts: the role of suture materials and surgical techniques on reducing anastomotic compliance mismatch. Eur J Vasc Endovasc Surg 2003; 25: 287–295.CrossRefGoogle ScholarPubMed
24. Hasson, JE, Megerman, J, Abbott, WM. Increased compliance near vascular anastomoses. J Vasc Surg 1985; 2: 419–423.CrossRefGoogle ScholarPubMed
25. Nakashima, S, Sugimoto, H, Inoue, M, Karashima, S, Onitsuka, T, Koga, Y. Growth of the aortic anastomosis in puppies-comparison of monofilament suture materials, whether absorbable or nonabsorbable, and of suture techniques, whether continuous or interrupted. Nippon Geka Gakkai Zasshi 1991; 92: 206–213.Google ScholarPubMed
26. Chikamatsu, E, Sakurai, T, Nishikimi, N, Yano, T, Nimura, Y. Comparison of laser vascular welding, interrupted sutures, and continuous sutures in growing vascular anastomoses. Lasers Surg Med 1995; 16: 34–40.CrossRefGoogle ScholarPubMed
27. Tozzi, P, Hayoz, D, Ruchat, P, et al. Animal model to compare the effects of suture technique on cross-sectional compliance on end-to-side anastomoses. Eur J Cardiothorac Surg 2001; 19: 477–481.CrossRefGoogle ScholarPubMed
28. Hawkins, JA, Minich, LL, Tani, LY, Ruttenberg, HD, Sturtevant, JE, McGough, EC. Absorbable polydioxanone suture and results in total anomalous pulmonary venous connection. Ann Thorac Surg 1995; 60: 55–59.CrossRefGoogle ScholarPubMed
29. Pae, WE Jr, Waldhausen, JA, Prophet, GA, Pierce, WS. Primary vascular anastomosis in growing pigs: comparison of polypropylene and polyglycolic acid sutures. J Thorac Cardiovasc Surg 1981; 81: 921–927.CrossRefGoogle ScholarPubMed