PMCID: PMC4053497 DOI: 10.1016/j.jtcvs.2013.10.057
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.
The Journal of thoracic and cardiovascular surgery
Blalock-Taussig Procedure; Child, Preschool; Coronary Angiography; Female; Heart Defects, Congenital; Heart Ventricles; Hemodynamics; Humans; Male; North America; Norwood Procedures; Pulmonary Artery; Treatment Outcome
Congenital heart defects; CHD; Children; Norwood Operation; Blalock-Taussig Operation; Outcomes
Aiyagari, R., Rhodes, J. F., Shrader, P., Radtke, W. A., Bandisode, V. M., Bergersen, L., Gillespie, M. J., Gray, R. G., Guey, L. T., Hill, K. D., Hirsch, R., Kim, D. W., Lee, K., Pelech, A. N., Ringewald, J., Takao, C., Vincent, J. A., Ohye, R. G., ., Shirali, G. S. Impact of pre-stage II hemodynamics and pulmonary artery anatomy on 12-month outcomes in the Pediatric Heart Network Single Ventricle Reconstruction trial. The Journal of thoracic and cardiovascular surgery 148, 1467-1474 (2014).