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Influence of Shunt Type on Survival and Right Heart Function after the Norwood Procedure for Aortic Atresia.
- Source :
-
Seminars in thoracic and cardiovascular surgery [Semin Thorac Cardiovasc Surg] 2022 Winter; Vol. 34 (4), pp. 1300-1310. Date of Electronic Publication: 2021 Nov 25. - Publication Year :
- 2022
-
Abstract
- The study objective was to compare the results after Norwood procedure between modified Blalock-Taussig shunt (MBTS) and right ventricle-to-pulmonary artery conduit (RVPAC) according to Sano in patients with hypoplastic left heart syndrome (HLHS) and aortic atresia (AA). A total of 146 neonates with HLHS and AA who underwent the Norwood procedure at our institution between 2001 and 2020 were divided into 2 groups according to shunt type (MBTS or RVPAC). Survival after the Norwood procedure was compared between the groups. Longitudinal right ventricular and tricuspid valve function in each group were evaluated using cubic splines method. RVPAC was performed in 103 patients and MBTS in 43 according to surgeon preference. There were no differences in the 30-day mortality rates (16.5% vs 16.3%, P  = 0.973). Survival at 0.5, 1 and 3 years was 79.6%, 74.6%, and 68.9% in RVPAC and 66.8%, 64.3%, and 58.5% in MBTS (P  =  0.293). Among 23 patients undergoing tricuspid valve procedure, different mechanisms of tricuspid regurgitation were observed between the groups. Longitudinal analysis revealed greater prevalence of late right ventricular dysfunction in RVPAC patients. In 77 patients who completed Fontan procedure, the postoperative N-terminal pro B-type natriuretic peptide value was significantly higher in RVPAC vs MBTS (554 vs 276 ng/L, P  =  0.007). No survival advantage of RVPAC over MBTS was observed in neonates with HLHS and AA undergoing the Norwood procedure. Longitudinal analysis demonstrated a greater prevalence of right ventricular dysfunction and higher N-terminal pro B-type natriuretic peptide values during late follow-up in patients with RVPAC.<br /> (Copyright © 2021 Elsevier Inc. All rights reserved.)
- Subjects :
- Infant, Newborn
Humans
Natriuretic Peptide, Brain
Treatment Outcome
Pulmonary Artery diagnostic imaging
Pulmonary Artery surgery
Heart Ventricles diagnostic imaging
Heart Ventricles surgery
Ventricular Dysfunction, Right
Norwood Procedures
Hypoplastic Left Heart Syndrome diagnostic imaging
Hypoplastic Left Heart Syndrome surgery
Blalock-Taussig Procedure adverse effects
Aortic Diseases
Subjects
Details
- Language :
- English
- ISSN :
- 1532-9488
- Volume :
- 34
- Issue :
- 4
- Database :
- MEDLINE
- Journal :
- Seminars in thoracic and cardiovascular surgery
- Publication Type :
- Academic Journal
- Accession number :
- 34838954
- Full Text :
- https://doi.org/10.1053/j.semtcvs.2021.11.012