Right ventricle to pulmonary artery conduit improves outcome after stage I Norwood for hypoplastic left heart syndrome

Christian Pizarro, Edward Malec, Kevin O. Maher, Katarzyna Januszewska, Samuel S. Gidding, Kenneth A Murdison, Jeanne M. Baffa, William I. Norwood

Research output: Contribution to journalArticle

154 Citations (Scopus)

Abstract

Background - Diastolic run off into the pulmonary circulation and labile coronary perfusion are thought to contribute to morbidity and mortality after the Norwood procedure (NP). We compared outcomes from the use of a RV to PA conduit (RV/PA) or a modified Blalock-Taussig shunt (BTS), physiologically distinct sources of pulmonary blood flow. Methods and Results - Review of 56 consecutive patients who underwent a Norwood procedure with a RV/PA (n=36) or a BTS (n = 20) between 2000 and 2002. Median age was 4.5 days (range 1 to 40) and median weight was 3.1 kg (range 1.8 to 4.1). The RV/PA was constructed with a 5-mm conduit. Patients in the BTS group received a 4-mm shunt. Comparisons between RV/PA and BTS groups showed no difference for weight, gestational age, prenatal diagnosis, HLHS variant, associated diagnoses, ascending aortic size, ventricular function, AV valve function, and pulmonary venous obstruction. Operative survival was higher with RV/PA [33/36 (92%) versus 14/20 (70%); P=0.05]. Patients with RV/PA had less need for ventilatory manipulations to balance the Qp/Qs (1/36 v/s 8/20; P=0.001), delayed sternal closure (6/36 v/s 7/20; P=0.001), and extracorporeal support (5/36 v/s 7/20; P=0.036). RV/PA patients had more favorable postoperative hemodynamics: higher diastolic blood pressure without changes in systolic blood pressure at 1, 8, 24, 48 hours after the NP (46.3 v/s 39.5; 47.2 v/s 42.1; 46.1 v/s 37.1; and 47.1 v/s 40.2; all P = 0.001). Conclusion - RV/PA simplifies postoperative management and improves hospital survival after NP for HLHS.

Original languageEnglish (US)
JournalCirculation
Volume108
Issue number10 SUPPL.
StatePublished - Sep 9 2003
Externally publishedYes

Fingerprint

Norwood Procedures
Blalock-Taussig Procedure
Hypoplastic Left Heart Syndrome
Pulmonary Artery
Heart Ventricles
Blood Pressure
Weights and Measures
Pulmonary Valve
Pulmonary Circulation
Survival
Ventricular Function
Prenatal Diagnosis
Gestational Age
Perfusion
Hemodynamics
Hypertension
Morbidity
Lung
Mortality

Keywords

  • Congenital
  • Heart defects
  • Heart surgery
  • Risk factors

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Physiology (medical)

Cite this

Pizarro, C., Malec, E., Maher, K. O., Januszewska, K., Gidding, S. S., Murdison, K. A., ... Norwood, W. I. (2003). Right ventricle to pulmonary artery conduit improves outcome after stage I Norwood for hypoplastic left heart syndrome. Circulation, 108(10 SUPPL.).

Right ventricle to pulmonary artery conduit improves outcome after stage I Norwood for hypoplastic left heart syndrome. / Pizarro, Christian; Malec, Edward; Maher, Kevin O.; Januszewska, Katarzyna; Gidding, Samuel S.; Murdison, Kenneth A; Baffa, Jeanne M.; Norwood, William I.

In: Circulation, Vol. 108, No. 10 SUPPL., 09.09.2003.

Research output: Contribution to journalArticle

Pizarro, C, Malec, E, Maher, KO, Januszewska, K, Gidding, SS, Murdison, KA, Baffa, JM & Norwood, WI 2003, 'Right ventricle to pulmonary artery conduit improves outcome after stage I Norwood for hypoplastic left heart syndrome', Circulation, vol. 108, no. 10 SUPPL..
Pizarro, Christian ; Malec, Edward ; Maher, Kevin O. ; Januszewska, Katarzyna ; Gidding, Samuel S. ; Murdison, Kenneth A ; Baffa, Jeanne M. ; Norwood, William I. / Right ventricle to pulmonary artery conduit improves outcome after stage I Norwood for hypoplastic left heart syndrome. In: Circulation. 2003 ; Vol. 108, No. 10 SUPPL.
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abstract = "Background - Diastolic run off into the pulmonary circulation and labile coronary perfusion are thought to contribute to morbidity and mortality after the Norwood procedure (NP). We compared outcomes from the use of a RV to PA conduit (RV/PA) or a modified Blalock-Taussig shunt (BTS), physiologically distinct sources of pulmonary blood flow. Methods and Results - Review of 56 consecutive patients who underwent a Norwood procedure with a RV/PA (n=36) or a BTS (n = 20) between 2000 and 2002. Median age was 4.5 days (range 1 to 40) and median weight was 3.1 kg (range 1.8 to 4.1). The RV/PA was constructed with a 5-mm conduit. Patients in the BTS group received a 4-mm shunt. Comparisons between RV/PA and BTS groups showed no difference for weight, gestational age, prenatal diagnosis, HLHS variant, associated diagnoses, ascending aortic size, ventricular function, AV valve function, and pulmonary venous obstruction. Operative survival was higher with RV/PA [33/36 (92{\%}) versus 14/20 (70{\%}); P=0.05]. Patients with RV/PA had less need for ventilatory manipulations to balance the Qp/Qs (1/36 v/s 8/20; P=0.001), delayed sternal closure (6/36 v/s 7/20; P=0.001), and extracorporeal support (5/36 v/s 7/20; P=0.036). RV/PA patients had more favorable postoperative hemodynamics: higher diastolic blood pressure without changes in systolic blood pressure at 1, 8, 24, 48 hours after the NP (46.3 v/s 39.5; 47.2 v/s 42.1; 46.1 v/s 37.1; and 47.1 v/s 40.2; all P = 0.001). Conclusion - RV/PA simplifies postoperative management and improves hospital survival after NP for HLHS.",
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T1 - Right ventricle to pulmonary artery conduit improves outcome after stage I Norwood for hypoplastic left heart syndrome

AU - Pizarro, Christian

AU - Malec, Edward

AU - Maher, Kevin O.

AU - Januszewska, Katarzyna

AU - Gidding, Samuel S.

AU - Murdison, Kenneth A

AU - Baffa, Jeanne M.

AU - Norwood, William I.

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N2 - Background - Diastolic run off into the pulmonary circulation and labile coronary perfusion are thought to contribute to morbidity and mortality after the Norwood procedure (NP). We compared outcomes from the use of a RV to PA conduit (RV/PA) or a modified Blalock-Taussig shunt (BTS), physiologically distinct sources of pulmonary blood flow. Methods and Results - Review of 56 consecutive patients who underwent a Norwood procedure with a RV/PA (n=36) or a BTS (n = 20) between 2000 and 2002. Median age was 4.5 days (range 1 to 40) and median weight was 3.1 kg (range 1.8 to 4.1). The RV/PA was constructed with a 5-mm conduit. Patients in the BTS group received a 4-mm shunt. Comparisons between RV/PA and BTS groups showed no difference for weight, gestational age, prenatal diagnosis, HLHS variant, associated diagnoses, ascending aortic size, ventricular function, AV valve function, and pulmonary venous obstruction. Operative survival was higher with RV/PA [33/36 (92%) versus 14/20 (70%); P=0.05]. Patients with RV/PA had less need for ventilatory manipulations to balance the Qp/Qs (1/36 v/s 8/20; P=0.001), delayed sternal closure (6/36 v/s 7/20; P=0.001), and extracorporeal support (5/36 v/s 7/20; P=0.036). RV/PA patients had more favorable postoperative hemodynamics: higher diastolic blood pressure without changes in systolic blood pressure at 1, 8, 24, 48 hours after the NP (46.3 v/s 39.5; 47.2 v/s 42.1; 46.1 v/s 37.1; and 47.1 v/s 40.2; all P = 0.001). Conclusion - RV/PA simplifies postoperative management and improves hospital survival after NP for HLHS.

AB - Background - Diastolic run off into the pulmonary circulation and labile coronary perfusion are thought to contribute to morbidity and mortality after the Norwood procedure (NP). We compared outcomes from the use of a RV to PA conduit (RV/PA) or a modified Blalock-Taussig shunt (BTS), physiologically distinct sources of pulmonary blood flow. Methods and Results - Review of 56 consecutive patients who underwent a Norwood procedure with a RV/PA (n=36) or a BTS (n = 20) between 2000 and 2002. Median age was 4.5 days (range 1 to 40) and median weight was 3.1 kg (range 1.8 to 4.1). The RV/PA was constructed with a 5-mm conduit. Patients in the BTS group received a 4-mm shunt. Comparisons between RV/PA and BTS groups showed no difference for weight, gestational age, prenatal diagnosis, HLHS variant, associated diagnoses, ascending aortic size, ventricular function, AV valve function, and pulmonary venous obstruction. Operative survival was higher with RV/PA [33/36 (92%) versus 14/20 (70%); P=0.05]. Patients with RV/PA had less need for ventilatory manipulations to balance the Qp/Qs (1/36 v/s 8/20; P=0.001), delayed sternal closure (6/36 v/s 7/20; P=0.001), and extracorporeal support (5/36 v/s 7/20; P=0.036). RV/PA patients had more favorable postoperative hemodynamics: higher diastolic blood pressure without changes in systolic blood pressure at 1, 8, 24, 48 hours after the NP (46.3 v/s 39.5; 47.2 v/s 42.1; 46.1 v/s 37.1; and 47.1 v/s 40.2; all P = 0.001). Conclusion - RV/PA simplifies postoperative management and improves hospital survival after NP for HLHS.

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