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

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

机构地区：[1]School of Medicine,University of Missouri-Kansas City,Kansas City,MO 64108,USA [2]Department of Cardiovascular and Thoracic Surgery,Division of Pediatric Cardiothoracic Surgery,West Virginia University,Morgantown,WV 26506,USA [3]Department of Surgery,Parkview Health,Fort Wayne,IN 46845,USA [4]Department of Surgery,Division of Congenital Cardiac Surgery,Children’s Mercy Hospital,Kansas City,MO 64108,USA

出　　处：《Congenital Heart Disease》2024年第5期435-443,共9页先天性心脏病（英文）

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 preference.Shunt choice has been informed by landmark trials including the Single Ventricle Reconstruction trial and modern outcomes data may engender future complementary studies.Methods: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 type.The primary outcome measure was freedom from death or transplant.Secondary outcome measures included hospital length of stay,complications,and unplanned interventions.Results: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 RVPAS.There 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 interventions.These 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.

关 键 词：Hypoplastic left heart syndrome Norwood procedure Sano RVPAS univentricular heart 

分 类 号：R541[医药卫生—心血管疾病]