Evaluation of a Venous Unifocalization of the Bilateral Superior Vena Cava and Comparison with the Bilateral Bidirectional Glenn Procedure

Abstract

Objective: A bilateral-bidirectional Glenn procedure is generally performed in patients with a functional single ventricle and a bilateral superior vena cava. In bilateral superior vena cava, unbalanced blood flow due to its unique anatomy and reduced volume due to its small aperture can cause blood stasis, unbalanced pulmonary blood flow, and thrombosis formation. Unifocalization of bilateral superior vena cava, a new surgical technique which makes pulmonary blood flow more equally distributed, was performed and evaluated.
Methods: We retrospectively reviewed the clinical and surgical records of 65 patients who underwent Glenn procedure at the Juntendo University Hospital, Tokyo, from January 1997 to March 2014. Sixteen patients had bilateral superior vena cava anatomy. Unifocalization of superior vena cava was performed in 8 cases and conventional surgery in 8. Perioperative data were evaluated to compare outcomes and clinical courses between the two groups.
Results: There were no significant differences between the 2 groups in age (group 1: 1.0±0.5, group 2: 1.2±1.1, years of age), body weight (group 1: 7.7±2.3, group 2: 6.5±4.3, kg), change in central venous pressure before and after the operation (group 1: 6.5±3.1, group 2: 9.9±6.2, mmHg), postoperative oxygen saturation (group 1: 82±3.3, group 2: 83±9.3, %), duration of surgery (group 1: 371±120, group 2: 439±168, min), or cardiopulmonary bypass time (group 1: 143±38, group 2: 131±53, min). Unilateral blood flow, which is purportedly better than bilateral bidirectional Glenn procedure, was achieved without any disadvantages that are reported of the conventional procedure.
Conclusion: There was no distinct advantage or disadvantage to using the new method.