Survival and right ventricular performance for matched children after stage-1 Norwood: Modified Blalock-Taussig shunt versus right-ventricle-to-pulmonary-artery conduit Read at the 95th Annual Meeting of the American Association for Thoracic Surgery, Seattle, Washington, April 25-29, 2015.

Travis J. Wilder, Brian W. McCrindle, Alistair B. Phillips, Eugene H. Blackstone, Jeevanantham Rajeswaran, William G. Williams, William M. Decampli, Jeffrey P. Jacobs, Marshall L. Jacobs, Tara Karamlou, Paul M. Kirshbom, Gary K. Lofland, Gerhard Ziemer, Edward J. Hickey

Research output: Contribution to journalArticle

Abstract

Objective Early survival advantages after Norwood with right-ventricle-(RV)-to-pulmonary-artery conduit (NW-RVPA) over Norwood-operation with a Blalock-Taussig shunt (NW-BT) are offset by concerns regarding delayed RV dysfunction. We compared trends in survival, RV dysfunction, and tricuspid valve regurgitation (TR) between NW-RVPA and NW-BT for propensity-matched neonates with critical left ventricular outflow tract obstruction (LVOTO). Methods In an inception cohort (2005-2014; 21 institutions), 454 neonates with critical LVOTO underwent Norwood stage 1. Propensity-score matching paired 169 NW-RVPA patients with 169 NW-BT patients. End-states were compared between NW-RVPA and NW-BT using competing-risks, multiphase, parametric, hazard analysis. Post-Norwood echocardiogram reports (n = 2993) were used to grade RV dysfunction and TR. Time-related prevalence of <moderate RV dysfunction and TR were characterized using nonlinear mixed-model regression, and compared between groups via multiphase, parametric models. Results Overall 6-year survival was better after NW-RVPA (70%) versus NW-BT (55%; P <.001). Additionally, transplant-free survival during this time was better after NW-RVPA (64%) versus NW-BT (53%; P =.004). Overall prevalence of moderate RV dysfunction reached 11% within 3 months post-Norwood. During this time, RV dysfunction after NW-BT was 16% versus 6% after NW-RVPA (P =.02), and coincided temporally with an increased early hazard for death. For survivors, late RV dysfunction was <5% and was not different between groups (P =.36). Overall prevalence of <moderate TR reached 13% at 2 years post-Norwood and was increased after NW-BT (16%) versus NW-RVPA (11%; P =.003). Late TR was similar between groups. Conclusions Among propensity-score-matched neonates with critical LVOTO, NW-RVPA offers superior 6-year survival with no greater prevalence of RV dysfunction or TR than conventional NW-BT operations.

Original languageEnglish (US)
Pages (from-to)1440-1452.e8
JournalJournal of Thoracic and Cardiovascular Surgery
Volume150
Issue number6
DOIs
StatePublished - Dec 2015

Keywords

  • Norwood operation
  • congenital heart disease
  • critical left ventricular outflow tract obstruction
  • hypoplastic left heart syndrome
  • single ventricle

ASJC Scopus subject areas

  • Surgery
  • Pulmonary and Respiratory Medicine
  • Cardiology and Cardiovascular Medicine

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