Right ventricular to pulmonary artery conduit instead of modified Blalock-Taussig shunt improves postoperative hemodynamics in newborns after the norwood operation

Mair, Rudolf; Tulzer, Gerald; Sames, Eva; Gitter, Roland; Lechner, Evelyn; Steiner, Jürgen; Hofer, Anna; Geiselseder, Gertraud; Gross, Christoph

doi:10.1016/s0022-5223(03)00389-1

Cited by 132 publications

(97 citation statements)

References 9 publications

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“…We have recently shown that these encouraging early signs may be translated into improved right ventricular performance in the convalescent phase. 26 Clearly 26 catheterisation data of others, 25 and increased survival to stage 2 palliation 23 would all suggest improved, rather than diminished right ventricular function in patients with a conduit.…”

Section: Right Ventricle To Pulmonary Artery Conduit: a Recent Modifimentioning

confidence: 98%

The intensive care of infants with hypoplastic left heart syndrome

Theilen

Shekerdemian²

2005

Archives of Disease in Childhood - Fetal and Neonatal Edition

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Section: Right Ventricle To Pulmonary Artery Conduit: a Recent Modifimentioning

confidence: 98%

The intensive care of infants with hypoplastic left heart syndrome

Theilen

Shekerdemian²

2005

Archives of Disease in Childhood - Fetal and Neonatal Edition

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“…This would suggest that, in our hands, these patients would have had a better outcome with a standard Norwood approach. The classical Norwood procedure, using a systemicpulmonary shunt, has been criticised for similar reasons in terms of the continuous diastolic flow [9], but has not been associated with such profound diastolic hypotension or reversed diastolic flow. This may be because the haemodynamic effects of an unrestrictive AP window are more dramatic than those of a Gore-Tex shunt (which is both more peripheral in the circulation, narrower and longer, resulting in an inbuilt degree of fixed resistance which helps to dampen the degree of diastolic run-off).…”

Section: Discussionmentioning

confidence: 99%

Creation of aorto-pulmonary window with pulmonary artery band is not good palliation for hypoplastic left heart syndrome

Hosein

Mehta

Stickley

et al. 2007

European Journal of Cardio-Thoracic Surgery

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Objective: A small sub-group of patients with hypoplastic left heart syndrome (HLHS) have normal-sized ascending aorta and arch. An alternative to the Norwood I procedure in these patients is the creation of an aorto-pulmonary (AP) window with a distal pulmonary artery band (PAB). We reviewed our experience with this technique and compared outcomes to the Norwood procedure for HLHS. Methods: All patients treated for HLHS in a single institution between 1992 and 2005 were analysed. This identified 13 patients treated with AP window and PAB compared to 333 patients undergoing stage I Norwood procedure. An unrestrictive AP window was created and the main PA was banded. Patient records and echocardiograms were analysed. Median follow-up was 10 (IQR 0-655) days and 100% complete. Results: There were seven early deaths (54%) in the AP window group and two conversions to Norwood circulation. This was a significantly worse outcome than for the Norwood procedure over the same period, which had an early mortality of 29% ( p = 0.03). Kaplan-Meier actuarial analysis demonstrated a continued survival benefit of the Norwood group at 6 months ( p = 0.0005). Deaths were due to either low cardiac output syndrome (n = 4) or sudden unheralded arrest (n = 3). This occurred despite aortic cross-clamp and circulatory arrest times being significantly lower in the AP window group compared to the Norwood group (35 AE 27 vs 55 AE 16 min, p < 0.01 and 16 AE 29 vs 55 AE 20 min, p < 0.01, respectively). No differences in arterial saturations or systolic blood pressure existed between the groups, but diastolic blood pressure was significantly lower in the AP window group at 27 AE 10 mmHg compared to 42 AE 8 mmHg in the Norwood group ( p = 0.01) with evidence of flow reversal in the descending aorta. Differences in diastolic blood pressure between groups were abolished after conversion to stage II. Conclusions: Despite favourable anatomy and shorter ischaemic times, the AP window/PAB technique has a poor outcome compared to the Norwood procedure for HLHS. Low diastolic blood pressure with reversal of descending aortic flow in diastole was a feature of the AP window/PAB circulation. We recommend the Norwood procedure for these sub-types. This may have implications for newer 'hybrid' procedures for HLHS which create a similar palliative circulation. #

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“…Several case series report improved short-term survival with the Sano modification [1,3,9,10]. Retrospective reviews have demonstrated no early or midterm survival differences between the mBTS or the Sano modification [4,[11][12][13].…”

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confidence: 99%