A Comparison of the Modified Blalock-Taussig Shunt With the Right Ventricle-to-Pulmonary Artery Conduit

• Published in: The Annals of thoracic surgery Vol. 91; no. 5; pp. 1479 - 1485
• Main Authors: Fiore, Andrew C., MD, Tobin, Courtney, MD, Jureidini, Saadeh, MD, Rahimi, Mohammad, MD, Kim, Eric S., MS, Schowengerdt, Kenneth, MD
• Format: Journal Article
• Language: English
• Published: New York, NY Elsevier Inc 01-05-2011; Elsevier
• Subjects: Anastomosis, Surgical - methods; Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy; Biological and medical sciences; Blalock-Taussig Procedure - methods; Blalock-Taussig Procedure - mortality; Cardiology. Vascular system; Cardiothoracic Surgery; Cohort Studies; Echocardiography, Doppler, Color; Female; Follow-Up Studies; Heart Ventricles - surgery; Hospital Mortality - trends; Humans; Hypoplastic Left Heart Syndrome - diagnostic imaging; Hypoplastic Left Heart Syndrome - mortality; Hypoplastic Left Heart Syndrome - surgery; Infant; Infant, Newborn; Length of Stay; Male; Medical sciences; Norwood Procedures - methods; Norwood Procedures - mortality; Pneumology; Polytetrafluoroethylene; Postoperative Complications - mortality; Postoperative Complications - physiopathology; Pulmonary Artery - diagnostic imaging; Pulmonary Artery - growth & development; Pulmonary Artery - surgery; Radiography; Retrospective Studies; Risk Assessment; Surgery; Survival Analysis; Treatment Outcome; SVC; pulmonary artery; RPA; hypoplastic left heart syndrome; 26; stage 2 palliation; SD; tricuspid regurgitation; RVPA; S1P; right ventricular end-diastolic pressure; cardiopulmonary bypass; modified Blalock-Taussig; MBT; left pulmonary artery; stage 1 palliation; RVEDP; HLHS; atrioventricular; S2P; PA; right ventricle to pulmonary artery; right pulmonary artery; CPB; AV; superior vena cava; LPA; TR; standard deviation; Right pulmonary artery; Anesthesia; Circulatory system; Shunt; Cardiology; Comparative study
• ISSN: 0003-4975; 1552-6259
• DOI: 10.1016/j.athoracsur.2010.11.062

Background This study compared the modified Blalock-Taussig (MBT) shunt with the right ventricle-to-pulmonary artery (RVPA) conduit with respect to outcome and PA growth. Methods PA growth was assessed in 19 MBT patients and in 15 RVPA patients before stage 2 palliation for hypoplastic left heart syndrome. The RVPA was done with a ringed Gore-Tex tube (W. L. Gore and Assoc, Flagstaff, AZ) at each anastomosis. Results The two cohorts had similar pre-Glenn demographic and hemodynamic data. No patient required transcatheter or surgical intervention on the shunt or PAs after stage 1 palliation. The branch PA growth was better in RVPA (McGoon ratio: MBT, 1.5 ± 0.2 vs RVPA, 2.0 ± 0.6; p < 0.003) and was significantly more balanced (right-to-left PA area ratio: MBT, 1.5 ± 0.5 vs RVPA, 0.9 ± 0.6; p = 0.002). The Nakata index trended higher in RVPA (MBT, 242A ± 90 mm2 /m2 vs RVPA, 267 ± 95 mm2 /m2 , p = 0.2). After stage 2 palliation, oxygen saturation trended higher in the RVPA (81% ± 5%) vs MBT cohort (77% ± 8%, p < 0.08). Conclusions The Norwood operation using a RVPA nonvalved conduit is associated with improved branch PA growth.