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Erschienen in: Pediatric Cardiology 1/2013

01.01.2013 | Original Article

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

verfasst von: Julia Fischbach, Nicodème Sinzobahamvya, Christoph Haun, Ehrenfried Schindler, Peter Zartner, Martin Schneider, Viktor Hraška, Boulos Asfour, Joachim Photiadis

Erschienen in: Pediatric Cardiology | Ausgabe 1/2013

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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.
Literatur
1.
Zurück zum Zitat 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 162:125–130PubMedCrossRef 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 162:125–130PubMedCrossRef
2.
Zurück zum Zitat Burkhart HM, Ashburn DA, Konstantinov IE et al (2005) Interdigitating arch reconstruction eliminates recurrent coarctation after the Norwood procedure. J Thorac Cardiovasc Surg 130:61–65PubMedCrossRef Burkhart HM, Ashburn DA, Konstantinov IE et al (2005) Interdigitating arch reconstruction eliminates recurrent coarctation after the Norwood procedure. J Thorac Cardiovasc Surg 130:61–65PubMedCrossRef
3.
Zurück zum Zitat 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 4:433–439PubMedCrossRef 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 4:433–439PubMedCrossRef
4.
Zurück zum Zitat Ghanayem NS, Hoffman GM, Mussatto KA et al (2003) Home surveillance program prevents interstage mortality following the Norwood procedure. J Thorac Cardiovasc Surg 126:1367–1377PubMedCrossRef Ghanayem NS, Hoffman GM, Mussatto KA et al (2003) Home surveillance program prevents interstage mortality following the Norwood procedure. J Thorac Cardiovasc Surg 126:1367–1377PubMedCrossRef
5.
Zurück zum Zitat 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 127:982–989PubMedCrossRef 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 127:982–989PubMedCrossRef
6.
Zurück zum Zitat 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 25:911–924PubMedCrossRef 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 25:911–924PubMedCrossRef
7.
Zurück zum Zitat Larrazabal LA, Selamet Tierney ES, Brown DW et al (2008) Ventricular function deteriorates with recurrent coarctation in hypoplastic left heart syndrome. Ann Thorac Surg 86:869–874PubMedCrossRef Larrazabal LA, Selamet Tierney ES, Brown DW et al (2008) Ventricular function deteriorates with recurrent coarctation in hypoplastic left heart syndrome. Ann Thorac Surg 86:869–874PubMedCrossRef
8.
Zurück zum Zitat 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 86:697–699PubMedCrossRef 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 86:697–699PubMedCrossRef
9.
Zurück zum Zitat 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 23:728–733PubMedCrossRef 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 23:728–733PubMedCrossRef
10.
Zurück zum Zitat 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] 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.
Zurück zum Zitat 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 3:185–190PubMedCrossRef 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 3:185–190PubMedCrossRef
12.
Zurück zum Zitat Norwood WI, Lang P, Casteneda AR, Campbell DN (1981) Experience with operation for hypoplastic left heart syndrome. J Thorac Cardiovasc Surg 82:511–519PubMed Norwood WI, Lang P, Casteneda AR, Campbell DN (1981) Experience with operation for hypoplastic left heart syndrome. J Thorac Cardiovasc Surg 82:511–519PubMed
13.
Zurück zum Zitat 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 362:1980–1992PubMedCrossRef 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 362:1980–1992PubMedCrossRef
14.
Zurück zum Zitat Photiadis J, Asfour B, Sinzobahamvya N et al (2006) Improved hemodynamics and outcome after modified Norwood operation on the beating heart. Ann Thorac Surg 81:976–981PubMedCrossRef Photiadis J, Asfour B, Sinzobahamvya N et al (2006) Improved hemodynamics and outcome after modified Norwood operation on the beating heart. Ann Thorac Surg 81:976–981PubMedCrossRef
15.
Zurück zum Zitat 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 29:551–556PubMedCrossRef 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 29:551–556PubMedCrossRef
16.
Zurück zum Zitat 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 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.
Zurück zum Zitat 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 23:991–995PubMedCrossRef 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 23:991–995PubMedCrossRef
18.
Zurück zum Zitat 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 91:816–822PubMedCrossRef 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 91:816–822PubMedCrossRef
19.
Zurück zum Zitat 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 27:801–806PubMedCrossRef 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 27:801–806PubMedCrossRef
20.
Zurück zum Zitat 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 126:504–510PubMedCrossRef 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 126:504–510PubMedCrossRef
21.
Zurück zum Zitat 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 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
22.
Zurück zum Zitat Sinzobahamvya N, Photiadis J, Kumpikaite et al (2006) Comprehensive Aristotle score: implications for the Norwood procedure. Ann Thorac Surg 81:1794–1800PubMedCrossRef Sinzobahamvya N, Photiadis J, Kumpikaite et al (2006) Comprehensive Aristotle score: implications for the Norwood procedure. Ann Thorac Surg 81:1794–1800PubMedCrossRef
Metadaten
Titel
Interventions After Norwood Procedure: Comparison of Sano and Modified Blalock–Taussig Shunt
verfasst von
Julia Fischbach
Nicodème Sinzobahamvya
Christoph Haun
Ehrenfried Schindler
Peter Zartner
Martin Schneider
Viktor Hraška
Boulos Asfour
Joachim Photiadis
Publikationsdatum
01.01.2013
Verlag
Springer-Verlag
Erschienen in
Pediatric Cardiology / Ausgabe 1/2013
Print ISSN: 0172-0643
Elektronische ISSN: 1432-1971
DOI
https://doi.org/10.1007/s00246-012-0396-3

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