TY - JOUR
T1 - Size of the right ventricle-to-pulmonary artery conduit impacts mid-term outcome after the Norwood procedure in patients weighing less than 3 kg
AU - Watanabe, Naruhito
AU - Anagnostopoulos, Petros V.
AU - Shinkawa, Takeshi
AU - Johnson, Natalie
AU - Azakie, Anthony
N1 - Publisher Copyright:
© 2012 The American Association for Thoracic Surgery
PY - 2012/11
Y1 - 2012/11
N2 - Objective The optimal shunt size for patients who have the Norwood operation with a right ventricle-to-pulmonary artery conduit is controversial. The goal of this study is to compare outcomes of 2 shunt sizes in this population. Methods Between 2002 and 2010, 75 consecutive patients diagnosed with hypoplastic left heart syndrome and its variants underwent the Norwood procedure with a right ventricle-to-pulmonary artery conduit. The outcomes of 20 neonates weighing <3 kg were analyzed. Results The cumulative 30-day stage 1 mortality was 97% (95% confidence interval, 88%-99%) for all patients (73/75), 20 of whom weighed <3 kg. Nine patients had a 6-mm (group 1) and 11 patients had a 5-mm (group 2) right ventricle–to-pulmonary artery conduit. Thirty-day stage 1 survival was 88% (8/9) in group 1 and 90% (10/11) in group 2 (P =.88). The central pulmonary artery confluence size at prebidirectional cavopulmonary shunt catheterization was 4.5 ± 1.2 mm in group 1 and 2.5 ± 1.0 mm in group 2 (P =.009). The mean transpulmonary gradient was higher in group 2 (7.8 ± 3.1 mm Hg vs 4.2 ± 1.9 mm Hg; P =.036). The incidence of pulmonary artery intervention was 16% (1/7) in group 1 and 75% (6/8) in group 2 (P =.030). Survival rate at 6 months was 66% (6/9) in group 1 and 70% (7/10) in group 2 (P =.89). Conclusions Use of a 6-mm right ventricle-to-pulmonary artery conduit showed better central pulmonary artery growth and less need for pulmonary artery intervention in the authors’ experience.
AB - Objective The optimal shunt size for patients who have the Norwood operation with a right ventricle-to-pulmonary artery conduit is controversial. The goal of this study is to compare outcomes of 2 shunt sizes in this population. Methods Between 2002 and 2010, 75 consecutive patients diagnosed with hypoplastic left heart syndrome and its variants underwent the Norwood procedure with a right ventricle-to-pulmonary artery conduit. The outcomes of 20 neonates weighing <3 kg were analyzed. Results The cumulative 30-day stage 1 mortality was 97% (95% confidence interval, 88%-99%) for all patients (73/75), 20 of whom weighed <3 kg. Nine patients had a 6-mm (group 1) and 11 patients had a 5-mm (group 2) right ventricle–to-pulmonary artery conduit. Thirty-day stage 1 survival was 88% (8/9) in group 1 and 90% (10/11) in group 2 (P =.88). The central pulmonary artery confluence size at prebidirectional cavopulmonary shunt catheterization was 4.5 ± 1.2 mm in group 1 and 2.5 ± 1.0 mm in group 2 (P =.009). The mean transpulmonary gradient was higher in group 2 (7.8 ± 3.1 mm Hg vs 4.2 ± 1.9 mm Hg; P =.036). The incidence of pulmonary artery intervention was 16% (1/7) in group 1 and 75% (6/8) in group 2 (P =.030). Survival rate at 6 months was 66% (6/9) in group 1 and 70% (7/10) in group 2 (P =.89). Conclusions Use of a 6-mm right ventricle-to-pulmonary artery conduit showed better central pulmonary artery growth and less need for pulmonary artery intervention in the authors’ experience.
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U2 - 10.1016/j.jtcvs.2012.07.061
DO - 10.1016/j.jtcvs.2012.07.061
M3 - Article
C2 - 22925566
AN - SCOPUS:85028092831
SN - 0022-5223
VL - 144
SP - 1091
EP - 1094
JO - Journal of Thoracic and Cardiovascular Surgery
JF - Journal of Thoracic and Cardiovascular Surgery
IS - 5
ER -