Thesis (Ph.D.) - Cairo University - Faculty of Medicine - Department of Cardiothoracic Surgery

Background and Rationale:Bidirectional Glenn shunt is a well-established procedure performed as a part of the single ventricle palliation pathway. It may also provide definitive palliation in certain patients. However, stroke and neurocognitive dysfunction are common after cardiac surgery with rates of approximately 3-6% and 30-50%, respectively. Given this high level of risk, a monitor capable of detecting perioperative cerebral ischemia could significantly reduce adverse events in this patient population. This study aims to report and compare early post-operative neurological outcome after on-pump, off pump or using temporary cavo-atrial shunt in bidirectional Glenn shunt operation using a neurological monitor capable of detecting ischemic events during congenital heart surgery. Patients and Methods:This prospective comparative non randomized controlled trial included 30 patients undergoneGlenn shunt. The study was done at the kasr Al ainy hospitals (Abul Reesh specialized pediatric Japanese hospital) Cairo university in the period between October 2015 and October 2017 after obtaining the acceptance of the local ethical committee and the written consent of the study patients. Patients were divided into two matching and equally-numbered groups: Group A contained 15 patients using cardiopulmonary bypass; while group B contained 15 patients withoutusing cardiopulmonary bypass. Cerebral oximetry was done using INVOS. Results: As regards operative time it was shorter in group B (p=0.003), post-operative fits in group A 2 patients (13%), in group B 3 patients (20%) the difference was statistically insignificant (p >0.05), there was a significant correlation between AUC and neurological outcome p=0.01

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