Background:Shunt repair for the Norwood procedure with either the right ventricle to pulmonary artery shunt(RVPAS)or the modified Blalock-Taussig-Thomas Shunt(BTTS)varies by institution and surgeon preference.Shunt ch...Background:Shunt repair for the Norwood procedure with either the right ventricle to pulmonary artery shunt(RVPAS)or the modified Blalock-Taussig-Thomas Shunt(BTTS)varies by institution and surgeon preference.Shunt choice has been informed by landmark trials including the Single Ventricle Reconstruction trial and modern outcomes data may engender future complementary studies.Methods:We conducted a retrospective analysis of all patients who underwent the Norwood procedure from 2014–2022 at a single center to compare outcomes by shunt type.The primary outcome measure was freedom from death or transplant.Secondary outcome measures included hospital length of stay,complications,and unplanned interventions.Results:93 patients underwent the Norwood procedure at a median age of 7 days(IQR 5,9)and 39 weeks gestation(IQR 38,39).67.7%had hypoplastic left heart syndrome.39 patients received a BTTS compared to 54 RVPAS.There was no difference in operative mortality(BTTS 12.8%,RVPAS 9.3%,p=0.58),death or transplant at 1 year(BTTS 15.4%,RVPAS 7.4%,p=0.31),or between 1 and 3 years(BTTS 0%,RVPAS 5.6%,p=0.26).There was a significantly higher rate of pulmonary arterial stenting in the RVPAS group(BTTS 1.21/100 patient-years,RVPAS 15.68/100 patient-years,p=0.01).Conclusions:Similar short-and medium-term survival were seen in BTTS and RVPAS groups with fewer pulmonary artery interventions for BTTS,though our study is underpowered to suggest superior freedom from interventions.These results may serve as a hypothesis-generating study to revisit the SVR trial with a modern cohort in the setting of improved surgical technique and perioperative management.展开更多
文摘Background:Shunt repair for the Norwood procedure with either the right ventricle to pulmonary artery shunt(RVPAS)or the modified Blalock-Taussig-Thomas Shunt(BTTS)varies by institution and surgeon preference.Shunt choice has been informed by landmark trials including the Single Ventricle Reconstruction trial and modern outcomes data may engender future complementary studies.Methods:We conducted a retrospective analysis of all patients who underwent the Norwood procedure from 2014–2022 at a single center to compare outcomes by shunt type.The primary outcome measure was freedom from death or transplant.Secondary outcome measures included hospital length of stay,complications,and unplanned interventions.Results:93 patients underwent the Norwood procedure at a median age of 7 days(IQR 5,9)and 39 weeks gestation(IQR 38,39).67.7%had hypoplastic left heart syndrome.39 patients received a BTTS compared to 54 RVPAS.There was no difference in operative mortality(BTTS 12.8%,RVPAS 9.3%,p=0.58),death or transplant at 1 year(BTTS 15.4%,RVPAS 7.4%,p=0.31),or between 1 and 3 years(BTTS 0%,RVPAS 5.6%,p=0.26).There was a significantly higher rate of pulmonary arterial stenting in the RVPAS group(BTTS 1.21/100 patient-years,RVPAS 15.68/100 patient-years,p=0.01).Conclusions:Similar short-and medium-term survival were seen in BTTS and RVPAS groups with fewer pulmonary artery interventions for BTTS,though our study is underpowered to suggest superior freedom from interventions.These results may serve as a hypothesis-generating study to revisit the SVR trial with a modern cohort in the setting of improved surgical technique and perioperative management.
