HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH TABLE OF CONTENTS		QUICK SEARCH:   [advanced] Author: Keyword(s): Year:  Vol:  Page:

This Article Full Text Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Add to Personal Folders Download to citation manager Author home page(s): Geoffrey L. Bird Peter J. Gruber J. William Gaynor Thomas L. Spray Sarah Tabbutt Permission Requests Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Ballweg, J. A. Articles by Tabbutt, S. Search for Related Content PubMed PubMed Citation Articles by Ballweg, J. A. Articles by Tabbutt, S.

J Thorac Cardiovasc Surg 2007;134:297-303
© 2007 The American Association for Thoracic Surgery

Surgery for Congenital Heart Disease

A contemporary comparison of the effect of shunt type in hypoplastic left heart syndrome on the hemodynamics and outcome at stage 2 reconstruction

^a Department of Pediatrics, Division of Cardiology, Children’s Hospital of Philadelphia and University of Pennsylvania School of Medicine, Philadelphia, Pa
^b Department of Surgery, Division of Cardiothoracic Surgery, Children’s Hospital of Philadelphia and University of Pennsylvania School of Medicine, Philadelphia, Pa
^c Department of Anesthesiology and Critical Care Medicine, Children’s Hospital of Philadelphia and University of Pennsylvania School of Medicine, Philadelphia, Pa
^d Department of Pediatrics, Division of Cardiology, Children’s Hospital of Pittsburgh and University of Pittsburgh School of Medicine, Pittsburgh, Pa.

Received for publication February 1, 2007; accepted for publication February 21, 2007.

^_* Address for reprints: Jean Ballweg, MD, Cardiac Intensive Care Unit, The Children’s Hospital of Philadelphia, 34th St and Civic Center Blvd, Philadelphia, PA 19119. (Email: ballweg{at}email.chop.edu).

Objective: We compare the hemodynamics and perioperative course of shunt type in hypoplastic left heart syndrome at the time of stage 2 reconstruction and longer-term survival.

Methods: We retrospectively reviewed the echocardiograms, catheterizations, and hospital records of all patients who had a stage 1 reconstruction between January 2002 and May 2005 and performed a cross-sectional analysis of hospital survivors.

Results: One hundred seventy-six patients with hypoplastic left heart syndrome and variants underwent a stage 1 reconstruction with either a right ventricle–pulmonary artery conduit (n = 62) or a modified Blalock–Taussig shunt (n = 114). The median duration of follow-up is 29.1 months (range, 0-57 months). By means of Kaplan–Meier analysis, there is no difference in survival at 3 years (right ventricle–pulmonary artery conduit: 73% [95% confidence limit, 59%–83%] vs modified Blalock–Taussig shunt: 69% [95% confidence limit, 59%–77%]; P = .6). One hundred twenty-four patients have undergone stage 2 reconstruction (78 modified Blalock–Taussig shunts and 46 right ventricle–pulmonary artery conduits). At the time of the stage 2 reconstruction, patients with right ventricle–pulmonary artery conduits were younger (153 days [range, 108–340 days]; modified Blalock–Taussig shunt, 176 days [range, 80–318 days]; P = .03), had lower systemic oxygen saturation (73% [range, 58%–85%] vs 77% [range, 57%–89%], P < .01), and had higher preoperative hemoglobin levels (15.8 g/dL [range, 13–21 g/dL] vs 14.8 g/dL [range, 12–19 g/dL], P < .01) compared with those of the modified Blalock–Taussig shunt group. By means of echocardiographic evaluation, there was a higher incidence of qualitative ventricular dysfunction in patients with right ventricle–pulmonary artery conduits (14/46 [31%] vs 9/73 [12%], P = .02). However, no difference was observed in common atrial pressure or the arteriovenous oxygen difference.

Conclusion: Interim analyses suggest no advantage of one shunt type over another. This report raises concern of late ventricular dysfunction and outcome in patients with a right ventricle–pulmonary artery conduit.

This article has been cited by other articles:

				H. M. Phelps, W. T. Mahle, D. Kim, J. M. Simsic, P. M. Kirshbom, K. R. Kanter, and K. O. Maher Postoperative cerebral oxygenation in hypoplastic left heart syndrome after the Norwood procedure. Ann. Thorac. Surg., May 1, 2009; 87(5): 1490 - 1494. [Abstract] [Full Text] [PDF]

				S. Sano, S.-C. Huang, S. Kasahara, K. Yoshizumi, Y. Kotani, and K. Ishino Risk Factors for Mortality After the Norwood Procedure Using Right Ventricle to Pulmonary Artery Shunt Ann. Thorac. Surg., January 1, 2009; 87(1): 178 - 186. [Abstract] [Full Text] [PDF]

				J. Atallah, I. A. Dinu, A. R. Joffe, C. M.T. Robertson, R. S. Sauve, J. D. Dyck, D. B. Ross, I. M. Rebeyka, and the Western Canadian Complex Pediatric Therapies F Two-Year Survival and Mental and Psychomotor Outcomes After the Norwood Procedure: An Analysis of the Modified Blalock-Taussig Shunt and Right Ventricle-to-Pulmonary Artery Shunt Surgical Eras Circulation, September 30, 2008; 118(14): 1410 - 1418. [Abstract] [Full Text] [PDF]

				A. A. Kon Healthcare Providers Must Offer Palliative Treatment to Parents of Neonates With Hypoplastic Left Heart Syndrome Arch Pediatr Adolesc Med, September 1, 2008; 162(9): 844 - 848. [Full Text] [PDF]

				S. M. Bradley, C. C. Erdem, T.-Y. Hsia, A. M. Atz, V. Bandisode, and J. M. Ringewald Right Ventricle-to-Pulmonary Artery Shunt: Alternative Palliation in Infants With Inadequate Pulmonary Blood Flow Prior to Two-Ventricle Repair Ann. Thorac. Surg., July 1, 2008; 86(1): 183 - 188. [Abstract] [Full Text] [PDF]