Similar Interstage Outcomes for Single Ventricle Infants Palliated With an Aortopulmonary Shunt Compared to the Norwood Procedure

Pizzuto, Matthew; Patel, Mehul D.; Romano, Jennifer C.; Retzloff, Lauren; Yu, Sunkyung; Lowery, Ray; Gelehrter, Sarah

doi:10.1177/2150135118768720

Cited by 4 publications

(1 citation statement)

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“…Although it is known that patients with single ventricle physiology are at a three-fold higher risk of death after BTS, our result are very high compared to those in the current literature. [16][17][18][19][20] This result is attributed to the continuous forward flow of blood into the pulmonary artery during systole and diastole, which may cause myocardial ischemia and circulatory instability due to coronary steal, particularly for low-weight infants who undergo BTS under cardiopulmonary bypass. [16][17][18] In our cohort, the most common causes of death were multiple organ dysfunction due to sepsis, shunt occlusion, cardiogenic shock, and asphyxia by broncoaspiration.…”

Section: Commentmentioning

confidence: 99%

Single Ventricle Palliation in a Developing Sub-Saharan African Country: What Should be Improved?

Manuel

Morais

Turquetto

et al. 2019

World J Pediatr Congenit Heart Surg

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Introduction: Single ventricle physiology management is challenging, especially in low-income countries. Objective: To report the palliation outcomes of single ventricle patients in a developing African country. Methods: We retrospectively studied 83 consecutive patients subjected to single ventricle palliation in a single center between March 2011 and December 2017. Preoperative data, surgical factors, postoperative results, and survival outcomes were analyzed. The patients were divided by palliation stage: I (pulmonary artery banding [PAB] or Blalock-Taussig shunt [BTS]), II (Glenn procedure), or III (Fontan procedure). Results: Of the 83 patients who underwent palliation (stages I-III), 38 deaths were observed (31 after stage I, six after stage II, and one after stage III) for an overall mortality of 45.7%. The main causes of operative mortality were multiple organ dysfunction due to sepsis, shunt occlusion, and cardiogenic shock. Twenty-eight survivors were lost to follow-up (22 after stage I, six after stage II). Thirteen stage II survivors are still waiting for stage III. The mean follow-up was 366 + 369 days. Five-year survival was 28.4 % for PAB and 30.1% for BTS, while that for stage II and III was 49.8% and 57.1%, respectively. Age (hazard ratio, 0.61; 95% confidence interval: 0.47-0.7; P ¼ .000) and weight at surgery (hazard ratio, 0.45; 95% confidence interval: 0.31-0.64; P ¼ .002) impacted survival. Conclusion: A high-mortality rate was observed in this initial experience, mainly in stage I patients. A large number of patients were lost to follow-up. A task force to improve outcomes is urgently required.

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