The Norwood with Blalock-Taussig-Thomas Shunt—Worth a Second Look?

作     者：Manasa Gadiraju Dhaval Chauhan Alexandra Schray James EO’Brien Jr Edo KwakuSetsoafia Bedzra 

作者机构：School of MedicineUniversity of Missouri-Kansas CityKansas CityMO 64108USA Department of Cardiovascular and Thoracic SurgeryDivision of Pediatric Cardiothoracic SurgeryWest Virginia UniversityMorgantownWV 26506USA Department of SurgeryParkview HealthFort WayneIN 46845USA Department of SurgeryDivision of Congenital Cardiac SurgeryChildren’s Mercy HospitalKansas CityMO 64108USA 

出 版 物：《Congenital Heart Disease》 (先天性心脏病（英文）)

年 卷 期：2024年第19卷第5期

页      面：435-443页

学科分类：1002[医学-临床医学] 100214[医学-肿瘤学] 10[医学] 

主　　题：Hypoplastic left heart syndrome Norwood procedure Sano RVPAS univentricular heart 

摘      要：Background:Shunt repair for the Norwood procedure with either the right ventricle to pulmonary artery shunt(RVPAS)or the modified Blalock-Taussig-Thomas Shunt(BTTS)varies by institution and surgeon *** choice has been informed by landmark trials including the Single Ventricle Reconstruction trial and modern outcomes data may engender future complementary ***:We conducted a retrospective analysis of all patients who underwent the Norwood procedure from 2014–2022 at a single center to compare outcomes by shunt *** primary outcome measure was freedom from death or *** outcome measures included hospital length of stay,complications,and unplanned ***:93 patients underwent the Norwood procedure at a median age of 7 days(IQR 5,9)and 39 weeks gestation(IQR 38,39).67.7%had hypoplastic left heart syndrome.39 patients received a BTTS compared to 54 *** was no difference in operative mortality(BTTS 12.8%,RVPAS 9.3%,p=0.58),death or transplant at 1 year(BTTS 15.4%,RVPAS 7.4%,p=0.31),or between 1 and 3 years(BTTS 0%,RVPAS 5.6%,p=0.26).There was a significantly higher rate of pulmonary arterial stenting in the RVPAS group(BTTS 1.21/100 patient-years,RVPAS 15.68/100 patient-years,p=0.01).Conclusions:Similar short-and medium-term survival were seen in BTTS and RVPAS groups with fewer pulmonary artery interventions for BTTS,though our study is underpowered to suggest superior freedom from *** results may serve as a hypothesis-generating study to revisit the SVR trial with a modern cohort in the setting of improved surgical technique and perioperative management.