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Interventions After Norwood Procedure: Comparison of Sano and Modified Blalock–Taussig Shunt

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Abstract

Improved results have evolved from the modified Norwood procedure (NP). This study compares the incidence of interventions after NP with the Sano (n = 37) and modified Blalock–Taussig (BT n = 70) shunt. Incidence, location, interval of interventions, and weight were retrospectively analysed for 107 neonates undergoing NP during the period from October 2002 to December 2009. Forty-six (43.0 %) patients underwent interventions, mostly for dilatation of the aortic arch ([DAA] n = 26 [24.3 %]; Sano n = 10, BT n = 16, p = 0.6), dilatation of the shunt ([DS] n = 15 [14.0 %]; Sano n = 11, BT n = 4; p = 0.002), or closure of aortopulmonary collaterals ([APC] n = 15 [14.0 %]; Sano n = 3, BT n = 12; p = 0.08). Mean interval after NP and body weight at DAA, DS, and APC were 72.4 ± 18.9, 108.5 ± 15.8, and 110.7 ± 17.8 days and 4.5 ± 1.3, 4.9 ± 1.9, 5.3 ± 1.2 kg, respectively. The interventions were not associated with mortality but with a greater rate of complications (9 of 46 [21.4 %]) compared with the rate after diagnostic catheterization (0 of 45, p = 0.03). Complications included closure of the femoral or subclavian artery (n = 5), cerebral embolic or bleeding events (n = 4), cardiopulmonary resuscitation (n = 3), and temporary heart block (n = 2). Actuarial survival was similar from the postoperative month 8 onward at 78.6 ± 4.9 % (95 % confidence interval [CI] 67.0–86.5 %) for Sano and 78.4 ± 6.8 % (95 % CI 61.4–88.6 %) for BT (p = 0.95). Interventions after NP were common irrespective of shunt type. However, a significantly greater rate of shunt interventions was noted in the Sano group. In particular, interventions addressing the aortic arch and the shunt were related with a significant rate of complications.

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References

  1. Banka P, Sleeper LA, Atz AM et al (2011) Practice variability and outcomes of coil embolization of aortopulmonary collaterals before Fontan completion: a report from the Pediatric Heart Network Fontan Cross-Sectional Study. Am Heart J 162:125–130

    Article  PubMed  Google Scholar 

  2. Burkhart HM, Ashburn DA, Konstantinov IE et al (2005) Interdigitating arch reconstruction eliminates recurrent coarctation after the Norwood procedure. J Thorac Cardiovasc Surg 130:61–65

    Article  PubMed  Google Scholar 

  3. Desai T, Stumper O, Miller P et al (2009) Acute interventions for stenosed right ventricle-pulmonary artery conduit following the right-sided modification of Norwood-Sano procedure. Congenit Heart Dis 4:433–439

    Article  PubMed  Google Scholar 

  4. Ghanayem NS, Hoffman GM, Mussatto KA et al (2003) Home surveillance program prevents interstage mortality following the Norwood procedure. J Thorac Cardiovasc Surg 126:1367–1377

    Article  PubMed  CAS  Google Scholar 

  5. Jaquiss RD, Ghanayem NS, Hoffman GM et al (2004) Early cavopulmonary anastomosis in very young infants after the Norwood procedure: impact on oxygenation, resource utilization, and mortality. J Thorac Cardiovasc Surg 127:982–989

    Article  PubMed  Google Scholar 

  6. Lacour-Gayet F, Clarke D, Jacobs J, Aristotle Committee et al (2004) The Aristotle score: a complexity-adjusted method to evaluate surgical results. Eur J Cardiothorac Surg 25:911–924

    Article  PubMed  CAS  Google Scholar 

  7. Larrazabal LA, Selamet Tierney ES, Brown DW et al (2008) Ventricular function deteriorates with recurrent coarctation in hypoplastic left heart syndrome. Ann Thorac Surg 86:869–874

    Article  PubMed  Google Scholar 

  8. Lemler MS, Zellers TM, Harris KA, Ramaciotti C (2000) Coarctation index: identification of recurrent coarctation in infants with hypoplastic left heart syndrome after the Norwood procedure. Am J Cardiol 86:697–699

    Article  PubMed  CAS  Google Scholar 

  9. Malec E, Januszewska K, Kolcz J, Mroczek T (2003) Right ventricle-to-pulmonary artery shunt versus modified Blalock-Taussig shunt in the Norwood procedure for hypoplastic left heart syndrome—Influence on early and late haemodynamic status. Eur J Cardiothorac Surg 23:728–733

    Article  PubMed  Google Scholar 

  10. Murtuza B, Jones TJ, Barron DJ, Brawn WJ (2011, December 8) Temporary restriction of right ventricle-pulmonary artery conduit flow using haemostatic clips following Norwood I reconstruction: potential for improved outcomes. Interact Cardiovasc Thorac Surg [Epub ahead of print]

  11. Muyskens S, Nicolas R, Foerster S, Balzer D (2008) Endovascular stent placement for right ventricle to pulmonary artery conduit stenosis in the Norwood with Sano modification. Congenit Heart Dis 3:185–190

    Article  PubMed  Google Scholar 

  12. Norwood WI, Lang P, Casteneda AR, Campbell DN (1981) Experience with operation for hypoplastic left heart syndrome. J Thorac Cardiovasc Surg 82:511–519

    PubMed  CAS  Google Scholar 

  13. Ohye RG, Sleeper LA, Mahony L et al (2010) Pediatric Heart Network Investigators. Comparison of shunt types in the Norwood procedure for single-ventricle lesions. N Engl J Med 362:1980–1992

    Article  PubMed  CAS  Google Scholar 

  14. Photiadis J, Asfour B, Sinzobahamvya N et al (2006) Improved hemodynamics and outcome after modified Norwood operation on the beating heart. Ann Thorac Surg 81:976–981

    Article  PubMed  Google Scholar 

  15. Photiadis J, Sinzobahamvya N, Fink C et al (2006) Optimal pulmonary to systemic blood flow ratio for best hemodynamic status and outcome early after Norwood operation. Eur J Cardiothorac Surg 29:551–556

    Article  PubMed  Google Scholar 

  16. Photiadis J, Sinzobahamvya N, Haun C, et al. (2012) Does the shunt-type determine midterm outcome after Norwood operation? Eur J Cardiothorac Surg doi:10.1093/ejcts/ezr299

  17. Pizarro C, Norwood WI (2003) Right ventricle to pulmonary artery conduit has a favorable impact on postoperative physiology after stage I Norwood: preliminary results. Eur J Cardiothorac Surg 23:991–995

    Article  PubMed  Google Scholar 

  18. Rüffer A, Arndt F, Potapov S et al (2011) Early stage 2 palliation is crucial in patients with a right-ventricle-to-pulmonary-artery conduit. Ann Thorac Surg 91:816–822

    Article  PubMed  Google Scholar 

  19. Rumball EM, McGuirk SP, Stümper O et al (2005) The RV-PA conduit stimulates better growth of the pulmonary arteries in hypoplastic left heart syndrome. Eur J Cardiothorac Surg 27:801–806

    Article  PubMed  Google Scholar 

  20. Sano S, Ishino K, Kawada M, Arai S et al (2003) Right ventricle-to-pulmonary artery shunt in first-stage palliation of hypoplastic left heart syndrome. J Thorac Cardiovasc Surg 126:504–510

    Article  PubMed  Google Scholar 

  21. Schreiber C, Kasnar-Samprec J, Hörer J, et al. (209) Ring-enforced right ventricle-to-pulmonary artery conduit in Norwood stage I reduces proximal conduit stenosis. Ann Thorac Surg 88:1541–1545

    Google Scholar 

  22. Sinzobahamvya N, Photiadis J, Kumpikaite et al (2006) Comprehensive Aristotle score: implications for the Norwood procedure. Ann Thorac Surg 81:1794–1800

    Article  PubMed  Google Scholar 

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Authors and Affiliations

  1. Department of Pediatric Cardio-Thoracic Surgery, German Pediatric Heart Center (Deutsches Kinderherzzentrum), Asklepios Clinic Sankt Augustin, Arnold-Janssen-Strasse, 29 53757, Sankt Augustin, Germany

    Julia Fischbach, Nicodème Sinzobahamvya, Viktor Hraška, Boulos Asfour & Joachim Photiadis

  2. Department of Pediatric Cardiac Intensive Care, German Pediatric Heart Center (Deutsches Kinderherzzentrum), Asklepios Clinic Sankt Augustin, Sankt Augustin, Germany

    Christoph Haun

  3. Department of Pediatric Cardiac Anaesthesiology, German Pediatric Heart Center (Deutsches Kinderherzzentrum), Asklepios Clinic Sankt Augustin, Sankt Augustin, Germany

    Ehrenfried Schindler

  4. Department of Pediatric Cardiology, German Pediatric Heart Center (Deutsches Kinderherzzentrum), Asklepios Clinic Sankt Augustin, Sankt Augustin, Germany

    Peter Zartner & Martin Schneider

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  1. Julia Fischbach
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  2. Nicodème Sinzobahamvya
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  3. Christoph Haun
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  4. Ehrenfried Schindler
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  5. Peter Zartner
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  6. Martin Schneider
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  7. Viktor Hraška
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  8. Boulos Asfour
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  9. Joachim Photiadis
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Correspondence to Joachim Photiadis.

Additional information

Presented at 46th Annual Meeting of the Association for European Paediatric and Congenital Cardiology 25 May, 2012, Istanbul, Turkey

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Fischbach, J., Sinzobahamvya, N., Haun, C. et al. Interventions After Norwood Procedure: Comparison of Sano and Modified Blalock–Taussig Shunt. Pediatr Cardiol 34, 112–118 (2013). https://doi.org/10.1007/s00246-012-0396-3

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  • DOI: https://doi.org/10.1007/s00246-012-0396-3

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