Safety and Early Outcomes of Off-Pump Bidirectional Glenn Procedure in Pediatric Patients with Single-Ventricle Physiology: A Five-Year Single-Center Experience
Zara Shirazi1*, Ammad Hussain1, Javeria Khalid Khan1, Kajal Khatri1, Mahak Iqbal1, Sohail Khan Bangash3
1National Institute of Cardiovascular Diseases (NICVD), Karachi, Pakistan.
*Corresponding Author: Dr. Zara Shirazi, MBBS, FCPS (Cardiac Surgery) Clinical Fellow – Congenital Cardiac Surgery, National University Heart Centre Singapore and Former Fellow – Adult & Congenital Cardiac Surgery National Institute of Cardiovascular Diseases (NICVD), Karachi, Pakistan.
https://doi.org/10.58624/SVOAPD.2026.05.014
Received: May 20, 2026
Published: June 05, 2026
Citation: Shirazi Z, Hussain A, Khan JK, Khatri K, Iqbal M, Bangash SK. Safety and Early Outcomes of Off-Pump Bidirectional Glenn Procedure in Pediatric Patients with Single-Ventricle Physiology: A Five-Year Single-Center Experience. SVOA Paediatrics 2026, 5:3, 97-100. doi: 10.58624/ SVOAPD.2026.05.014
Abstract
Background: The bidirectional Glenn (BDG) procedure is a key step in staged palliation for single-ventricle physiology and is traditionally performed using cardiopulmonary bypass (CPB). Avoidance of CPB may reduce perioperative morbidity, particularly in resource-limited settings.
Methods: We performed a retrospective observational analysis of pediatric patients undergoing off-pump bidirectional Glenn procedures at a single tertiary cardiac center between January 2020 and January 2025. Demographic characteristics, operative details, and early postoperative outcomes were evaluated. Due to the retrospective nature of the study, analysis was limited to variables available from institutional records.
Results: Off-pump BDG was successfully completed in all selected patients without routine use of CPB (n = 96). The mean intensive care unit (ICU) stay was 3.1 days. Early postoperative complications occurred in 11.0% of patients, most commonly re-exploration for bleeding (four cases). No early mortality was observed.
Conclusion: In carefully selected pediatric patients, the off-pump bidirectional Glenn procedure is a feasible and safe surgical strategy, associated with acceptable early outcomes and efficient resource utilization.
Keywords: Single-ventricle physiology; Congenital heart surgery; Pediatric cardiac surgery; Cardiopulmonary bypass avoidance; Resource-limited settings; Congenital heart disease; Early postoperative outcomes.