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J Thorac Cardiovasc Surg 2003;126:1378-1384
© 2003 The American Association for Thoracic Surgery

Surgery for congenital heart disease

Right ventricular to pulmonary artery conduit instead of modified Blalock-Taussig shunt improves postoperative hemodynamics in newborns after the Norwood operation

Rudolf Mair, MDa,*, Gerald Tulzer, MDb, Eva Sames, MDa, Roland Gitter, MDb, Evelyn Lechner, MDb, Jürgen Steiner, MDb, Anna Hofer, MDc, Gertraud Geiselseder, MDc, Christoph Gross, MDa

a Department of Cardiac Surgery, General Hospital Linz, Linz, Austria
b Department of Pediatric Cardiology, Children’s Hospital Linz, Linz, Austria
c Department of Anaesthesiology, General Hospital Linz, Linz, Austria

Received for publication August 30, 2002; revisions received December 30, 2002; accepted for publication January 22, 2003.

* Address for reprints: Rudolf Mair, MD, Department of Cardiac Surgery, General Hospital Linz Krankenhausstrasse 9, 4020, Linz, Austria
rudolf.mair{at}akh.linz.at

OBJECTIVE:: Perioperative mortality, prolonged postoperative recovery after the Norwood procedure, and mortality between stage I and stage II might be related to shunt physiology. A right ventricular to pulmonary artery conduit offers a banded physiology in contrast to a Blalock-Taussig shunt. The purpose of this study was to assess the hemodynamic differences and their consequences in the postoperative course between Norwood patients with a Blalock-Taussig shunt and those with a right ventricular to pulmonary artery conduit.

METHODS: From October 1999 until May 2002, 32 unselected consecutive patients underwent a Norwood procedure at the General Hospital Linz. The first 18 patients received a Blalock-Taussig shunt. In the remaining 14 patients we performed a right ventricular to pulmonary artery conduit. Both groups were compared.

RESULTS: The diastolic blood pressure was significantly higher in the right ventricular to pulmonary artery conduit group (P < .001). Despite a higher FIO2, PO2 levels tended to be lower in the first 5 postoperative days. At the age of 3 months, catheterization labora- tory data showed a lower Qp/Qs ratio in the same group (0.86 [0.78; 1] versus 1.55 [1.15; 1.6]; P = .005) and a higher dp/dt (955 [773; 1110] vs 776 [615; 907]; P = .018). (Descriptive data reflect medians and quartiles [in brackets].) Hospital survival was 72% in the Blalock-Taussig shunt group versus 93% in the right ventricular to pulmonary ar- tery conduit group. Mortality between stage I and stage II was 23% in the Blalock-Taussig shunt group versus 0% in the right ventricular to pulmonary artery conduit group.

CONCLUSIONS: A higher diastolic blood pressure and a lower Qp/Qs ratio were associated with a more stable and efficient circulation in patients with a right ventricular to pulmonary artery conduit. More intensive ventilatory support was necessary during the first postoperative days. We did not note any adverse effects of the ventriculotomy on ventricular performance.




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