title: Short and long-term outcomes for bidirectional glenn procedure performed with and without cardiopulmonary bypass.
abstract: BACKGROUND
  The bidirectional Glenn (BDG) procedure is most commonly used as staged palliation for complex cyanotic congenital heart defects. The benefits of a BDG procedure without the use of cardiopulmonary bypass (CPB) remain mixed within reported series. The purpose of this study was to compare short- and long-term outcomes for performance of a BDG procedure with and without the use of CPB.
  
  
  METHODS
  From 2001 to 2010, 106 patients underwent a BDG procedure. Patients were stratified into CPB (n = 72; age = 202 days) and non-CPB (n = 34; age = 182 days) groups. Primary outcomes included operative mortality and postoperative complications as well as differences in long-term Kaplan-Meier survival.
  
  
  RESULTS
  Median follow-up was 30 months. Preoperative patient characteristics were similar among patients despite the use of CPB. The most frequent indications for a BDG procedure were hypoplastic left heart syndrome (HLHS) (35.8%) and tricuspid atresia (TA) (17.9%). Median perfusion time was 73 minutes for CPB patients. Overall mortality was 0.9% and no deaths occurred among non-CPB patients (0.0% versus 1.4%; p > 0.99). Similarly, no significant differences existed between non-CPB patients and CPB patients with respect to overall complication rates (11.8% versus 18.1%; p = 0.57) or postoperative length of stay (7.0 [5.0-12.0] versus 7.0 [5.0-11.0] days; p = 0.38). Furthermore, 1-, 3-, and 5-year survival was high and similar between groups.
  
  
  CONCLUSIONS
  The BDG procedure can be performed with no significant differences in operative mortality, morbidity, or use of resources, with or without CPB support. Long-term survival after the BDG procedure is high with both strategies. Performance of an off-pump BDG procedure should be considered a safe alternative to the conventional use of CPB for appropriately selected patients.
authors.affiliation: Department of Surgery, Division of Thoracic and Cardiovascular Surgery, University of Virginia Health System, Charlottesville, Virginia 22908, USA.
authors.forename: Damien J
authors.initials: DJ
authors.lastname: LaPar
authors.forename: Carlos M
authors.initials: CM
authors.lastname: Mery
authors.forename: Benjamin B
authors.initials: BB
authors.lastname: Peeler
authors.forename: Irving L
authors.initials: IL
authors.lastname: Kron
authors.forename: James J
authors.initials: JJ
authors.lastname: Gangemi
mesh_terms: D002315:Cardiopulmonary Bypass; D018729:Fontan Procedure / Q000379:methods* / Q000401:mortality; D006295:Health Resources / Q000706:statistics & numerical data; D006330:Heart Defects, Congenital / Q000601:surgery*; D006801:Humans; D007223:Infant; D011183:Postoperative Complications / Q000453:epidemiology; D016896:Treatment Outcome