Document Detail


Right ventricular to pulmonary artery conduit instead of modified Blalock-Taussig shunt improves postoperative hemodynamics in newborns after the Norwood operation.
MedLine Citation:
PMID:  14666009     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
OBJECTIVE: Perioperative mortality, prolonged postoperative recovery after the Norwood procedure, and mortality between stage I and stage II might be related to shunt physiology. A right ventricular to pulmonary artery conduit offers a banded physiology in contrast to a Blalock-Taussig shunt. The purpose of this study was to assess the hemodynamic differences and their consequences in the postoperative course between Norwood patients with a Blalock-Taussig shunt and those with a right ventricular to pulmonary artery conduit. METHODS: From October 1999 until May 2002, 32 unselected consecutive patients underwent a Norwood procedure at the General Hospital Linz. The first 18 patients received a Blalock-Taussig shunt. In the remaining 14 patients we performed a right ventricular to pulmonary artery conduit. Both groups were compared. RESULTS: The diastolic blood pressure was significantly higher in the right ventricular to pulmonary artery conduit group (P <.001). Despite a higher FIO(2), PO(2) levels tended to be lower in the first 5 postoperative days. At the age of 3 months, catheterization laboratory data showed a lower Qp/Qs ratio in the same group (0.86 [0.78; 1] versus 1.55 [1.15; 1.6]; P =.005) and a higher dp/dt (955 [773; 1110] vs 776 [615; 907]; P =.018). (Descriptive data reflect medians and quartiles [in brackets].) Hospital survival was 72% in the Blalock-Taussig shunt group versus 93% in the right ventricular to pulmonary artery conduit group. Mortality between stage I and stage II was 23% in the Blalock-Taussig shunt group versus 0% in the right ventricular to pulmonary artery conduit group. CONCLUSIONS: A higher diastolic blood pressure and a lower Qp/Qs ratio were associated with a more stable and efficient circulation in patients with a right ventricular to pulmonary artery conduit. More intensive ventilatory support was necessary during the first postoperative days. We did not note any adverse effects of the ventriculotomy on ventricular performance.
Authors:
Rudolf Mair; Gerald Tulzer; Eva Sames; Roland Gitter; Evelyn Lechner; Jürgen Steiner; Anna Hofer; Gertraud Geiselseder; Christoph Gross
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Publication Detail:
Type:  Comparative Study; Journal Article    
Journal Detail:
Title:  The Journal of thoracic and cardiovascular surgery     Volume:  126     ISSN:  0022-5223     ISO Abbreviation:  J. Thorac. Cardiovasc. Surg.     Publication Date:  2003 Nov 
Date Detail:
Created Date:  2003-12-10     Completed Date:  2004-01-14     Revised Date:  2007-11-15    
Medline Journal Info:
Nlm Unique ID:  0376343     Medline TA:  J Thorac Cardiovasc Surg     Country:  United States    
Other Details:
Languages:  eng     Pagination:  1378-84     Citation Subset:  AIM; IM    
Affiliation:
Department of Cardiac Surgery, General Hospital Linz, Austria. rudolf.mair@akh.linz.at
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MeSH Terms
Descriptor/Qualifier:
Anastomosis, Surgical / methods
Cardiac Surgical Procedures / methods*,  mortality
Female
Heart Septal Defects, Ventricular / diagnosis,  mortality,  surgery*
Heart Ventricles / surgery
Hemodynamics*
Humans
Hypoplastic Left Heart Syndrome / diagnosis,  mortality,  surgery*
Infant, Newborn
Male
Postoperative Complications / prevention & control
Probability
Prognosis
Pulmonary Artery / surgery
Retrospective Studies
Risk Assessment
Sampling Studies
Statistics, Nonparametric
Survival Analysis
Treatment Outcome
Comments/Corrections
Comment In:
J Thorac Cardiovasc Surg. 2003 Nov;126(5):1268-70   [PMID:  14665995 ]

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


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