Document Detail


Right ventricle to pulmonary artery conduit reduces interim mortality after stage 1 Norwood for hypoplastic left heart syndrome.
MedLine Citation:
PMID:  15561008     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
BACKGROUND: Despite significant improvement in survival after stage 1 Norwood, interim mortality before the second-stage operation remains significant. On the basis of reports of improved circulatory stability associated with the use of a right ventricle to pulmonary artery conduit, the difference between two physiologically different sources of pulmonary blood flow on interim mortality was investigated. METHODS: Data collection of 96 consecutive hospital survivors after stage 1 Norwood surgery was undertaken. The source of pulmonary blood flow was a modified right Blalock-Taussig shunt in 46 (BTS) and a right ventricle to pulmonary artery conduit in 50 patients. The same follow-up protocol was used in both groups. Data analysis was performed to identify variables associated with interim mortality. RESULTS: Analysis of patient-related and procedure-related variables revealed no differences in age, weight, diagnosis, presence of aortic atresia, lowest perioperative pH, duration of cardiopulmonary bypass, circulatory arrest, length of mechanical ventilation, or hospital stay at the time of stage 1 Norwood between groups. Respiratory rate and systolic blood pressure were the only differences detected between groups at the time of discharge. Interim mortality was higher in the Blalock-Taussig shunt group. Statistical analysis identified aortic atresia, a modified Blalock-Taussig shunt, and the presence of perioperative dysrhythmias to be associated with interim mortality. CONCLUSIONS: The use of a right ventricle to pulmonary artery shunt decreases the incidence of interim mortality among hospital survivors after stage 1 Norwood for hypoplastic left heart syndrome. Aortic atresia, the use of a modified Blalock-Taussig shunt, and perioperative dysrhythmias are independently associated with a higher mortality before superior cavopulmonary connection.
Authors:
Christian Pizarro; Tomasz Mroczek; Edward Malec; William I Norwood
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Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  The Annals of thoracic surgery     Volume:  78     ISSN:  1552-6259     ISO Abbreviation:  Ann. Thorac. Surg.     Publication Date:  2004 Dec 
Date Detail:
Created Date:  2004-11-24     Completed Date:  2005-07-05     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  15030100R     Medline TA:  Ann Thorac Surg     Country:  Netherlands    
Other Details:
Languages:  eng     Pagination:  1959-63; discussion 1963-4     Citation Subset:  AIM; IM    
Affiliation:
Nemours Cardiac Center, Alfred I. duPont Hospital for Children, Wilmington, Delaware, USA. cpizarro@nemours.org
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MeSH Terms
Descriptor/Qualifier:
Aorta / surgery*
Cardiac Surgical Procedures / mortality*
Cohort Studies
Female
Heart Ventricles / surgery*
Humans
Hypoplastic Left Heart Syndrome / mortality,  surgery*
Infant, Newborn
Male
Pulmonary Artery / surgery*
Survival Analysis
Treatment Outcome

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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