Comparison of Norwood shunt types: do the outcomes differ 6 years later?
BACKGROUND: A modification to the Norwood procedure involving a right ventricle-to-pulmonary artery (RV-PA) shunt may improve early postoperative outcomes. Concerns remain about the effect of the right ventriculotomy required with this shunt on long-term ventricular function.
METHODS: Between January 2000 and April 2005, 76 patients underwent the Norwood procedure, 35 with a modified Blalock-Taussig shunt (mBTS) and 41 with a RV-PA shunt. Patients were monitored until death or September 1, 2009, with an average follow-up of 6.8 years. Cardiac catheterization, echocardiograms, perioperative Fontan courses, and need for cardiac transplantation were compared between groups.
RESULTS: Cumulative survival was 63% (22 of 35) in the mBTS group vs 78% (32 of 41) in the RV-PA group (p = 0.14). Pre-Fontan echocardiography revealed poorer ventricular function in RV-PA patients (p = 0.03). Cardiac transplantation was required in 6 of 32 (19%) patients with a prior RV-PA shunt vs 1 of 23 (4%) in the mBTS group (p = 0.06). This results in an almost identical cumulative transplant-free survival between groups; 60% (21 of 35) in the mBTS group and 63% (26 of 41) in the RV-PA group (p = 0.95).
CONCLUSIONS: Neither shunt offers a clear survival advantage through an average follow-up of 6.8 years. The RV-PA shunt results in impaired late ventricular function that may result in an increased need for cardiac transplantation.
The Annals of thoracic surgery
Anastomosis, Surgical; Cardiac Surgical Procedures; Child; Child, Preschool; Follow-Up Studies; Fontan Procedure; Heart Defects, Congenital; Heart Ventricles; Humans; Hypoplastic Left Heart Syndrome; Pulmonary Artery
Graham, Eric M.; Zyblewski, Sinai C.; Phillips, Jacob W.; Shirali, Girish S.; Bradley, Scott M.; Forbus, Geoffery A.; Bandisode, Varsha M.; and Atz, Andrew M., "Comparison of Norwood shunt types: do the outcomes differ 6 years later?" (2010). Manuscripts, Articles, Book Chapters and Other Papers. 918.