The study objective was to compare the results after Norwood procedure between modified
Blalock-Taussig shunt (MBTS) and right ventricle-to-pulmonary artery conduit (RVPAC)
according to Sano in patients with hypoplastic left heart syndrome (HLHS) and aortic
atresia (AA). A total of 146 neonates with HLHS and AA who underwent the Norwood procedure
at our institution between 2001 and 2020 were divided into 2 groups according to shunt
type (MBTS or RVPAC). Survival after the Norwood procedure was compared between the
groups. Longitudinal right ventricular and tricuspid valve function in each group
were evaluated using cubic splines method. RVPAC was performed in 103 patients and
MBTS in 43 according to surgeon preference. There were no differences in the 30-day
mortality rates (16.5% vs 16.3%, P = 0.973). Survival at 0.5, 1 and 3 years was 79.6%, 74.6%, and 68.9% in RVPAC and
66.8%, 64.3%, and 58.5% in MBTS (P = 0.293). Among 23 patients undergoing tricuspid valve procedure, different mechanisms
of tricuspid regurgitation were observed between the groups. Longitudinal analysis
revealed greater prevalence of late right ventricular dysfunction in RVPAC patients.
In 77 patients who completed Fontan procedure, the postoperative N-terminal pro B-type
natriuretic peptide value was significantly higher in RVPAC vs MBTS (554 vs 276 ng/L,
P = 0.007). No survival advantage of RVPAC over MBTS was observed in neonates with
HLHS and AA undergoing the Norwood procedure. Longitudinal analysis demonstrated a
greater prevalence of right ventricular dysfunction and higher N-terminal pro B-type
natriuretic peptide values during late follow-up in patients with RVPAC.
Graphical Abstract
Graphical Abstract
Keywords
Abbreviations:
AA (aortic atresia), AP (antero-posterior), AS (antero-septal), BCPS (bidirectional cavopulmonary shunt), CI (confidence interval), EF (ejection fraction), HLHS (hypoplastic left heart syndrome), IQR (interquartile ranges), MBTS (modified Blalock-Taussig shunt), NT-proBNP (N-terminal pro B-type natriuretic peptide), PA (pulmonary artery), RV (right ventricle), RVPAC (right ventricle to pulmonary artery conduit), S1P (stage I procedure), S2P (stage II procedure), S3P (stage III procedure), SP (septal-posterior), TCPC (total cavopulmonary connection), TR (tricuspid regurgitation), TV (tricuspid valve), zlog-proBNP (age-adjusted zlog value of NT-proBNP)To read this article in full you will need to make a payment
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Article info
Publication history
Published online: November 25, 2021
Footnotes
Funding: This study for Dr. Takashi Kido was supported by The Uehara Memorial Foundation (2018-C201).
Conflicts of Interest: The authors declare no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.
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- Commentary: Are We Any Closer to Understanding the Influence of Shunt Type in The Norwood Procedure?Seminars in Thoracic and Cardiovascular SurgeryVol. 34Issue 4
- PreviewPiber and colleagues from Munich present a single-center retrospective review of Sano right ventricle (RV) to pulmonary artery (PA) shunts vs modified Blalock-Taussig (BT) shunts in the Norwood procedure for hypoplastic left heart syndrome (HLHS) and aortic atresia.1 146 neonates with HLHS who underwent the Norwood between 2001 and 2020 were compared according to shunt type. Sano was performed in 103 patients and BT shunt in 43. There were no statistically significant differences in 30 day mortality or after Stage 2.
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