title: Cavopulmonary anastomosis without cardiopulmonary bypass.
abstract: OBJECTIVE
  There is an increasing trend to perform the bidirectional superior cavopulmonary (Glenn) anastomosis without cardiopulmonary bypass. In this report, we present our results of off-pump bidirectional Glenn operation done without using a venoatrial shunt to decompress the superior vena cava during clamping. [corrected].
  
  
  METHODS
  A prospective, non-randomized comparative study was conducted in 50 patients with functional single ventricle anomalies who underwent bidirectional Glenn anastomosis without cardiopulmonary bypass. The patients were divided into two groups: Group I (n = 25), where it was done without a veno-atrial shunt, and Group II (n = 25), where it was done with a veno-atrial shunt. Two patients in Group I and 4 patients in Group II had a bilateral bidirectional Glenn shunt. Five patients in Group I and three patients in Group II had a previous left modified Blalock-Taussig shunt. All patients underwent a complete neurological examination both preoperatively as well as postoperatively.
  
  
  RESULTS
  The early hospital mortality was 4% (2/50), one in each group. The median follow-up was 14 months. The mean internal venous pressure on clamping the superior vena cava was 37.07 ± 7.12 mmHg in Group I and 24 ± 4.4 mmHg in Group II. The mean clamp time was 9.85 ± 3.52 min in Group I and 21.3 ± 4.4 min in Group II. The transcranial pressure gradient was 62.37 ± 15.01 mmHg in Group I, while 65.08 ± 13.89 in Group II. The mean intensive care unit stay was 2.57 ± 75 days in Group I, 3.3 ± 1.09 in Group II. There were no major neurological complications apart from treatable convulsions in one case in Group I (4%), 2 cases in Group II (8%), and delayed recovery in one case (4%) in Group I.
  
  
  CONCLUSIONS
  Off-pump bidirectional Glenn operation without caval decompression is a safe, simple and more economic procedure.
authors: Department of Cardiovascular and Thoracic Surgery, Ain Shams University Hospitals, Cairo, Egypt.
authors: Ezzeldin A
authors: EA
authors: Mostafa
authors: Ashraf A H
authors: AA
authors: El Midany
authors: Mahmoud M
authors: MM
authors: Zalat
authors: Ahmed
authors: A
authors: Helmy
mesh_terms: D002315:Cardiopulmonary Bypass; D016009:Chi-Square Distribution; D002675:Child, Preschool; D003250:Constriction; D019299:Decompression, Surgical; D018610:Heart Bypass, Right / Q000009:adverse effects / Q000401:mortality; D006330:Heart Defects, Congenital / Q000401:mortality / Q000503:physiopathology / Q000601:surgery*; D006352:Heart Ventricles / Q000002:abnormalities / Q000503:physiopathology / Q000601:surgery*; D017052:Hospital Mortality; D006801:Humans; D007223:Infant; D007362:Intensive Care Units; D007902:Length of Stay; D011183:Postoperative Complications / Q000401:mortality / Q000628:therapy; D011446:Prospective Studies; D013997:Time Factors; D016896:Treatment Outcome; D014683:Vena Cava, Superior / Q000503:physiopathology / Q000601:surgery; D014690:Venous Pressure