title: Bidirectional Glenn on cardiopulmonary bypass: A comparison of three techniques.
abstract: OBJECTIVE
  To analyze the intraoperative and early results of the bidirectional Glenn (BDG) procedure performed on cardiopulmonary bypass (CPB) using three different techniques.
  
  
  METHODS
  Between September 2013 and June 2015, 75 consecutive patients (mean age 42 ± 34.4 months) undergoing BDG were randomly assigned to either technique I: open anastomosis or technique II: superior vena cava (SVC) cannulation or technique III: intermittent SVC clamping. We monitored the cerebral near infrared spectrophotometry (NIRS), SVC pressure, CPB time, intensive care unit (ICU) stay, and neurocognitive function.
  
  
  RESULTS
  Patients in technique III had abnormal lower NIRS values during the procedure (57 ± 7.4) compared to techniques I and II (64 ± 7.5 and 61 ± 8.0, P = 0.01). Postoperative SVC pressure in technique III was higher than other two groups (17.6 ± 3.7 mmHg vs. 14.2 ± 3.5 mmHg and 15.3 ± 2.0 mmHg in techniques I and II, respectively = 0.0008). CPB time was highest in technique II (44 ± 18 min) compared to techniques I and III (29 ± 14 min and 38 ± 16 min, P = 0.006), respectively. ICU stay was longer in technique III (30 ± 15 h) compared to the other two techniques (22 ± 8.5 h and 27 ± 8.3 h in techniques I and II, respectively = 0.04). No patient experienced significant neurocognitive dysfunction.
  
  
  CONCLUSIONS
  All techniques of BDG provided acceptable results. The open technique was faster and its use in smaller children merits consideration. The technique of intermittent clamping should be used as a last resort.
authors.affiliation: Department of Cardiothoracic and Vascular Surgery, All India Institute of Medical Sciences, New Delhi, India.
authors.forename: Sachin
authors.identifier: http://orcid.org/0000-0002-9063-7691
authors.initials: S
authors.lastname: Talwar
authors.affiliation: Department of Cardiothoracic and Vascular Surgery, All India Institute of Medical Sciences, New Delhi, India.
authors.forename: Manikala Vinod
authors.initials: MV
authors.lastname: Kumar
authors.affiliation: Department of Clinical Neuropsychology, All India Institute of Medical Sciences, New Delhi, India.
authors.forename: Ashima
authors.initials: A
authors.lastname: Nehra
authors.affiliation: Department of Cardiac Anaesthesiology, All India Institute of Medical Sciences, New Delhi, India.
authors.forename: Poonam
authors.initials: P
authors.lastname: Malhotra Kapoor
authors.affiliation: Department of Cardiac Anaesthesiology, All India Institute of Medical Sciences, New Delhi, India.
authors.forename: Neeti
authors.initials: N
authors.lastname: Makhija
authors.affiliation: Department of Biostatistics, All India Institute of Medical Sciences, New Delhi, India.
authors.forename: Vishnubhatla
authors.initials: V
authors.lastname: Sreenivas
authors.affiliation: Department of Cardiothoracic and Vascular Surgery, All India Institute of Medical Sciences, New Delhi, India.
authors.forename: Shiv Kumar
authors.initials: SK
authors.lastname: Choudhary
authors.affiliation: Department of Cardiothoracic and Vascular Surgery, All India Institute of Medical Sciences, New Delhi, India.
authors.forename: Balram
authors.initials: B
authors.lastname: Airan
mesh_terms: D000293:Adolescent; D002315:Cardiopulmonary Bypass; D002648:Child; D002675:Child, Preschool; D005260:Female; D018610:Heart Bypass, Right / Q000379:methods*; D006330:Heart Defects, Congenital / Q000601:surgery*; D006801:Humans; D007223:Infant; D007362:Intensive Care Units; D007902:Length of Stay; D008297:Male; D019965:Neurocognitive Disorders; D011183:Postoperative Complications; D011184:Postoperative Period; D011312:Pressure; D011651:Pulmonary Artery / Q000601:surgery; D013997:Time Factors; D016896:Treatment Outcome; D014683:Vena Cava, Superior / Q000601:surgery
keywords: bidirectional Glenn; cardiopulmonary bypass; techniques of Glenn; univentricular palliation