Size of the right ventricle-to-pulmonary artery conduit impacts mid-term outcome after the Norwood procedure in patients weighing less than 3 kg

• Published in: The Journal of thoracic and cardiovascular surgery Vol. 144; no. 5; pp. 1091 - 1094
• Main Authors: Watanabe, Naruhito, MD, Anagnostopoulos, Petros V., MD, Shinkawa, Takeshi, MD, Johnson, Natalie, BS, Azakie, Anthony, MD
• Format: Journal Article
• Language: English
• Published: New York, NY Mosby, Inc 01.11.2012; Elsevier
• Subjects: Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy; Biological and medical sciences; Body Weight; Cardiology. Vascular system; Cardiothoracic Surgery; Chi-Square Distribution; Female; Heart Ventricles - physiopathology; Heart Ventricles - surgery; Hemodynamics; Hospital Mortality; Humans; Hypoplastic Left Heart Syndrome - mortality; Hypoplastic Left Heart Syndrome - physiopathology; Hypoplastic Left Heart Syndrome - surgery; Infant Mortality; Infant, Newborn; Male; Medical sciences; Norwood Procedures - adverse effects; Norwood Procedures - mortality; Pneumology; Pulmonary Artery - growth & development; Pulmonary Artery - physiopathology; Pulmonary Artery - surgery; Reoperation; Retrospective Studies; Risk Assessment; Risk Factors; San Francisco; Survival Analysis; Time Factors; Treatment Outcome; San Francisco; bidirectional cavopulmonary shunt; right ventricle–pulmonary artery; SVC; pulmonary artery; hypoplastic left heart syndrome; mBTS; HLHS; PA; RV-PA; modified Blalock–Taussig shunt; superior vena cava; BCPS; 20; Human; Prognosis; Size; Right pulmonary artery; Anesthesia; Patient; Procedure; Circulatory system; Cardiology
• ISSN: 0022-5223; 1097-685X
• DOI: 10.1016/j.jtcvs.2012.07.061

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.