External shunt versus internal shunt for off-pump Glenn

Background Off-pump bidirectional Glenn (BDG) operation can be associated with elevation of superior vena cava (SVC) pressure that may lead to neurological damage. Aim Off-pump BDG operation was done using either a veno-atrial shunt or external shunt to decompress SVC during clamping. Patients and methods A prospective, randomized comparative study in a single tertiary care cardiac center where 30 patients with functional single ventricle underwent off-pump BDG. Group I with a veno-atrial shunt (internal) and group E with an external shunt. Measurements and main results There was no early hospital mortality. The mean SVC pressure during clamping was 40.4±3.4 mmHg before and 28.5±3.8 mmHg after shunt opening in group I and 37.6±4.5 mmHg before and 26.4±2.1 mmHg after shunt opening in group E. The mean clamp time was 19.8±3.5 min in group I and 16.9±4.4 min in group E. The transcranial pressure gradient was 58.1±6.89 mmHg in group I, while 54.86±9.1 mmHg in group E. There were no major neurological complications apart from treatable convulsions in one (3%) case in group I and delayed recovery in one (3%) case in group E. Conclusions Off-pump BDG can be safely performed with either external or internal shunt avoiding cardiopulmonary bypass complications.