Short-term outcome comparison of Norwood procedures with right ventricle to pulmonary artery conduit versus modified Blalock-Taussig shunt: A meta-analysis

Abstract

A small number of nonrandomized and retrospective studies have compared outcomes of classical Norwood procedures for hypoplasticleft-heart syndrome and single ventricle lesions involving a Blalock-Taussig (BT) shunt to the modified procedure using a right ventricle to pulmonary artery conduit. Some of these studies reported data for the same outcomes and a meta-analysis was done to analyze pooled outcomes comparing in-hospital mortality, interstage mortality, cardiopulmonary bypass time, systolic and diastolic blood pressures 24 h postoperatively, length of intensive care and hospital stay, and need for postoperative extracorporeal membrane oxygenation. Right ventricle to pulmonary artery conduit was associated with an insignificant reduction of in-hospital mortality (odds ratio, 0.674, 95% confidence interval, 0.367 to 1.238), and in the length of hospital stay. There were significant reductions in cardiopulmonary bypass time, length of intensive care unit stay, and need for postoperative extracorporeal membrane oxygenation, postoperative ventilation times, and interstage mortality (odds ratio, 0.191, confidence interval, 0.0620 to 0.587). There was a significant increase in diastolic blood pressure and an insignificant increase in systolic blood pressure 24 h postoperatively. This pooled analysis demonstrates potential advantages associated with the right ventricle to pulmonary artery conduit when compared to the modified BT shunt in palliation and demonstrates the need for large randomized controlled trials that compare a number of outcomes in both procedures.

The Impact of the Left Ventricle on Right Ventricular Function and Clinical Outcomes in Infants with Single–Right Ventricle Anomalies up to 14 Months of Age

“…1,25 Our study also found that there was no significant association between anatomic subtype or LV size and clinical outcome. We surmise that LV size is not the determining factor in early outcome after staged palliation for single–right ventricle anomalies, likely because there are so many other issues associated with survival in this very vulnerable population, such as distal arch obstruction, 26 shunt obstruction, 27 and noncardiac issues. 28…”

Mathematical Analysis and Physical Profile of Blalock-Taussig Shunt and Sano Modification Procedure in Hypoplastic Left Heart Syndrome: Review of the Literature and Implications for the Anesthesiologist

“…With the advent of the RV-PA shunt, several studies have shown improvements in short-term morbidity variables and a consistent increase in aortic diastolic pressure and pulmonary artery growth. 68,69 The improved diastolic pressure is associated with the decreased diastolic run-off phenomenon (diastolic steal) and improved coronary perfusion. A review of postmortem Norwood cases at Children's Hospital in Boston revealed that impaired coronary perfusion and maldistribution of pulmonary blood flow were the causes of death in 63% of cases.…”

Surgical correction of hypoplastic left heart syndrome: a new approach

“…This overload (associated with the ventriculotomy) may lead to ventricle dysfunction and arrhythmia. Both techniques necessarily use an artificial tube, which increases the risk for thrombosis or stenosis ( 5 - 9 ). Moreover, creating the neo-aorta is a laborious procedure that involves the prolonged use of extracorporeal circulation (ECC).…”