Document Type

Article

Publication Date

10-1-2014

Identifier

PMCID: PMC4053497 DOI: 10.1016/j.jtcvs.2013.10.057

Abstract

OBJECTIVE: To compare the interstage cardiac catheterization hemodynamic and angiographic findings between shunt types for the Pediatric Heart Network Single Ventricle Reconstruction trial. The trial, which randomized subjects to a modified Blalock-Taussig shunt (MBTS) or right ventricle-to-pulmonary artery shunt (RVPAS) for the Norwood procedure, demonstrated the RVPAS was associated with a smaller pulmonary artery diameter but superior 12-month transplant-free survival.

METHODS: We analyzed the pre-stage II catheterization data for the trial subjects. The hemodynamic variables and shunt and pulmonary angiographic data were compared between shunt types; their association with 12-month transplant-free survival was also evaluated.

RESULTS: Of 549 randomized subjects, 389 underwent pre-stage II catheterization. A smaller size, lower aortic and superior vena cava saturation, and higher ventricular end-diastolic pressure were associated with worse 12-month transplant-free survival. The MBTS group had a lower coronary perfusion pressure (27 vs 32 mm Hg; P

CONCLUSIONS: Compared with the RVPAS subjects, the MBTS subjects had more hemodynamic abnormalities related to shunt physiology, and the RVPAS subjects had more shunt or pulmonary obstruction of a severe degree and inferior pulmonary artery growth at pre-stage II catheterization. A lower body surface area, greater ventricular end-diastolic pressure, and lower superior vena cava saturation were associated with worse 12-month transplant-free survival.

Journal Title

The Journal of thoracic and cardiovascular surgery

Volume

148

Issue

4

First Page

1467

Last Page

1474

MeSH Keywords

Blalock-Taussig Procedure; Child, Preschool; Coronary Angiography; Female; Heart Defects, Congenital; Heart Ventricles; Hemodynamics; Humans; Male; North America; Norwood Procedures; Pulmonary Artery; Treatment Outcome

Keywords

CHD; Children; Norwood Operation; Blalock-Taussig Operation; Outcomes

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