Outcomes After the Stage I Reconstruction Comparing the Right Ventricular to Pulmonary Artery Conduit With the Modified Blalock Taussig Shunt
Recent reports advocate that a right ventricular to pulmonary artery (RV-PA) conduit improves outcome after the stage I reconstruction. We retrospectively compared the outcomes of all neonates who underwent a stage I reconstruction between January 1, 2002, and October 1, 2004, with use of the RV-PA...
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| Veröffentlicht in: | The Annals of thoracic surgery 2005-11, Vol.80 (5), p.1582-1591 |
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| container_title | The Annals of thoracic surgery |
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| creator | Tabbutt, Sarah Dominguez, Troy E. Ravishankar, Chitra Marino, Bradley S. Gruber, Peter J. Wernovsky, Gil Gaynor, J. William Nicolson, Susan C. Spray, Thomas L. |
| description | Recent reports advocate that a right ventricular to pulmonary artery (RV-PA) conduit improves outcome after the stage I reconstruction.
We retrospectively compared the outcomes of all neonates who underwent a stage I reconstruction between January 1, 2002, and October 1, 2004, with use of the RV-PA conduit and modified Blalock-Taussig shunt (mBTS) interspersed over this time period.
In all, 149 infants underwent a stage I reconstruction (95 mBTS, 54 RV-PA) for hypoplastic left heart syndrome (HLHS) or variants. There was a preference for the RV-PA conduit in patients with aortic atresia (mBTS 30% versus RV-PA 67%, p < 0.01). There was no difference in surgical mortality (mBTS 14% versus RV-PA 17%, p = 0.67), time to extubation (mBTS 4.5 ± 4.8 days versus RV-PA 3.9 ± 3.5 days, p = 0.47), or length of hospital stay (mBTS 25 ± 29 days versus RV-PA 21 ± 23 days, p = 0.52). There was an increased incidence of shunt reinterventions in the patients with the RV-PA conduit (mBTS 17% versus RV-PA 32%, p = 0.04). Patients with RV-PA conduit returned earlier for stage II reconstruction (mBTS 6.5 ± 2.5 months versus RV-PA 5.6 ± 1.7 months, p = 0.05). There was no difference in overall mortality (mBTS 32% versus RV-PA 30%, p = 0.45) with a median duration of follow-up of 18 ± 8 months.
Comparing shunt strategies (mBTS versus RV-PA) over the same time period, we found no difference in outcome. These data support the need for a larger prospective, randomized trial. |
| doi_str_mv | 10.1016/j.athoracsur.2005.04.046 |
| format | Article |
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We retrospectively compared the outcomes of all neonates who underwent a stage I reconstruction between January 1, 2002, and October 1, 2004, with use of the RV-PA conduit and modified Blalock-Taussig shunt (mBTS) interspersed over this time period.
In all, 149 infants underwent a stage I reconstruction (95 mBTS, 54 RV-PA) for hypoplastic left heart syndrome (HLHS) or variants. There was a preference for the RV-PA conduit in patients with aortic atresia (mBTS 30% versus RV-PA 67%, p < 0.01). There was no difference in surgical mortality (mBTS 14% versus RV-PA 17%, p = 0.67), time to extubation (mBTS 4.5 ± 4.8 days versus RV-PA 3.9 ± 3.5 days, p = 0.47), or length of hospital stay (mBTS 25 ± 29 days versus RV-PA 21 ± 23 days, p = 0.52). There was an increased incidence of shunt reinterventions in the patients with the RV-PA conduit (mBTS 17% versus RV-PA 32%, p = 0.04). Patients with RV-PA conduit returned earlier for stage II reconstruction (mBTS 6.5 ± 2.5 months versus RV-PA 5.6 ± 1.7 months, p = 0.05). There was no difference in overall mortality (mBTS 32% versus RV-PA 30%, p = 0.45) with a median duration of follow-up of 18 ± 8 months.
Comparing shunt strategies (mBTS versus RV-PA) over the same time period, we found no difference in outcome. These data support the need for a larger prospective, randomized trial.</description><identifier>ISSN: 0003-4975</identifier><identifier>EISSN: 1552-6259</identifier><identifier>DOI: 10.1016/j.athoracsur.2005.04.046</identifier><identifier>PMID: 16242421</identifier><language>eng</language><publisher>Netherlands: Elsevier Inc</publisher><subject>Arteriovenous Shunt, Surgical ; Humans ; Hypoplastic Left Heart Syndrome - mortality ; Hypoplastic Left Heart Syndrome - surgery ; Infant, Newborn ; Pulmonary Artery - surgery ; Retrospective Studies ; Risk Factors ; Survival Analysis</subject><ispartof>The Annals of thoracic surgery, 2005-11, Vol.80 (5), p.1582-1591</ispartof><rights>2005 The Society of Thoracic Surgeons</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c458t-2b87fab3b14dd6162d50b4c57a6fc8b2911b6ead1eb31a1cb09a329abe110bf13</citedby><cites>FETCH-LOGICAL-c458t-2b87fab3b14dd6162d50b4c57a6fc8b2911b6ead1eb31a1cb09a329abe110bf13</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktohtml>$$Uhttps://dx.doi.org/10.1016/j.athoracsur.2005.04.046$$EHTML$$P50$$Gelsevier$$H</linktohtml><link.rule.ids>314,777,781,3537,27905,27906,45976</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/16242421$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Tabbutt, Sarah</creatorcontrib><creatorcontrib>Dominguez, Troy E.</creatorcontrib><creatorcontrib>Ravishankar, Chitra</creatorcontrib><creatorcontrib>Marino, Bradley S.</creatorcontrib><creatorcontrib>Gruber, Peter J.</creatorcontrib><creatorcontrib>Wernovsky, Gil</creatorcontrib><creatorcontrib>Gaynor, J. William</creatorcontrib><creatorcontrib>Nicolson, Susan C.</creatorcontrib><creatorcontrib>Spray, Thomas L.</creatorcontrib><title>Outcomes After the Stage I Reconstruction Comparing the Right Ventricular to Pulmonary Artery Conduit With the Modified Blalock Taussig Shunt</title><title>The Annals of thoracic surgery</title><addtitle>Ann Thorac Surg</addtitle><description>Recent reports advocate that a right ventricular to pulmonary artery (RV-PA) conduit improves outcome after the stage I reconstruction.
We retrospectively compared the outcomes of all neonates who underwent a stage I reconstruction between January 1, 2002, and October 1, 2004, with use of the RV-PA conduit and modified Blalock-Taussig shunt (mBTS) interspersed over this time period.
In all, 149 infants underwent a stage I reconstruction (95 mBTS, 54 RV-PA) for hypoplastic left heart syndrome (HLHS) or variants. There was a preference for the RV-PA conduit in patients with aortic atresia (mBTS 30% versus RV-PA 67%, p < 0.01). There was no difference in surgical mortality (mBTS 14% versus RV-PA 17%, p = 0.67), time to extubation (mBTS 4.5 ± 4.8 days versus RV-PA 3.9 ± 3.5 days, p = 0.47), or length of hospital stay (mBTS 25 ± 29 days versus RV-PA 21 ± 23 days, p = 0.52). There was an increased incidence of shunt reinterventions in the patients with the RV-PA conduit (mBTS 17% versus RV-PA 32%, p = 0.04). Patients with RV-PA conduit returned earlier for stage II reconstruction (mBTS 6.5 ± 2.5 months versus RV-PA 5.6 ± 1.7 months, p = 0.05). There was no difference in overall mortality (mBTS 32% versus RV-PA 30%, p = 0.45) with a median duration of follow-up of 18 ± 8 months.
Comparing shunt strategies (mBTS versus RV-PA) over the same time period, we found no difference in outcome. These data support the need for a larger prospective, randomized trial.</description><subject>Arteriovenous Shunt, Surgical</subject><subject>Humans</subject><subject>Hypoplastic Left Heart Syndrome - mortality</subject><subject>Hypoplastic Left Heart Syndrome - surgery</subject><subject>Infant, Newborn</subject><subject>Pulmonary Artery - surgery</subject><subject>Retrospective Studies</subject><subject>Risk Factors</subject><subject>Survival Analysis</subject><issn>0003-4975</issn><issn>1552-6259</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2005</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNqFkctOHDEQRS2UCCYkv4C8yq4Hux_u7uUwCgkSEQhIsrT8qJ720G1P_IjER-SfMcxILJFLsko-t0rXFyFMyZISys63SxFH54UKyS9LQpolqXOxI7SgTVMWrGz6D2hBCKmKum-bE_QphG1uy_x8jE4oK-t86AL9v0lRuRkCXg0RPI4j4PsoNoCv8B0oZ0P0SUXjLF67eSe8sZtX6M5sxoh_g43eqDSJLHX4Nk2zs8I_4ZXP056yxupkIv5j4vgq--m0GQxofDGJyalH_CBSCGaD78dk42f0cRBTgC-H-xT9uvz2sP5RXN98v1qvrgtVN10sStm1g5CVpLXWLJvRDZG1alrBBtXJsqdUMhCagqyooEqSXlRlLyRQSuRAq1P0dT93593fBCHy2QQF0yQsuBQ461rK-qrNYLcHlXcheBj4zps5G-SU8Jco-Ja_RcFfouCkzsWy9OywI8kZ9Jvw8PcZuNgDkJ3-M-B5UAasAm08qMi1M-9veQY8OKMS</recordid><startdate>200511</startdate><enddate>200511</enddate><creator>Tabbutt, Sarah</creator><creator>Dominguez, Troy E.</creator><creator>Ravishankar, Chitra</creator><creator>Marino, Bradley S.</creator><creator>Gruber, Peter J.</creator><creator>Wernovsky, Gil</creator><creator>Gaynor, J. William</creator><creator>Nicolson, Susan C.</creator><creator>Spray, Thomas L.</creator><general>Elsevier Inc</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope></search><sort><creationdate>200511</creationdate><title>Outcomes After the Stage I Reconstruction Comparing the Right Ventricular to Pulmonary Artery Conduit With the Modified Blalock Taussig Shunt</title><author>Tabbutt, Sarah ; Dominguez, Troy E. ; Ravishankar, Chitra ; Marino, Bradley S. ; Gruber, Peter J. ; Wernovsky, Gil ; Gaynor, J. William ; Nicolson, Susan C. ; Spray, Thomas L.</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c458t-2b87fab3b14dd6162d50b4c57a6fc8b2911b6ead1eb31a1cb09a329abe110bf13</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2005</creationdate><topic>Arteriovenous Shunt, Surgical</topic><topic>Humans</topic><topic>Hypoplastic Left Heart Syndrome - mortality</topic><topic>Hypoplastic Left Heart Syndrome - surgery</topic><topic>Infant, Newborn</topic><topic>Pulmonary Artery - surgery</topic><topic>Retrospective Studies</topic><topic>Risk Factors</topic><topic>Survival Analysis</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Tabbutt, Sarah</creatorcontrib><creatorcontrib>Dominguez, Troy E.</creatorcontrib><creatorcontrib>Ravishankar, Chitra</creatorcontrib><creatorcontrib>Marino, Bradley S.</creatorcontrib><creatorcontrib>Gruber, Peter J.</creatorcontrib><creatorcontrib>Wernovsky, Gil</creatorcontrib><creatorcontrib>Gaynor, J. William</creatorcontrib><creatorcontrib>Nicolson, Susan C.</creatorcontrib><creatorcontrib>Spray, Thomas L.</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><jtitle>The Annals of thoracic surgery</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Tabbutt, Sarah</au><au>Dominguez, Troy E.</au><au>Ravishankar, Chitra</au><au>Marino, Bradley S.</au><au>Gruber, Peter J.</au><au>Wernovsky, Gil</au><au>Gaynor, J. William</au><au>Nicolson, Susan C.</au><au>Spray, Thomas L.</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Outcomes After the Stage I Reconstruction Comparing the Right Ventricular to Pulmonary Artery Conduit With the Modified Blalock Taussig Shunt</atitle><jtitle>The Annals of thoracic surgery</jtitle><addtitle>Ann Thorac Surg</addtitle><date>2005-11</date><risdate>2005</risdate><volume>80</volume><issue>5</issue><spage>1582</spage><epage>1591</epage><pages>1582-1591</pages><issn>0003-4975</issn><eissn>1552-6259</eissn><abstract>Recent reports advocate that a right ventricular to pulmonary artery (RV-PA) conduit improves outcome after the stage I reconstruction.
We retrospectively compared the outcomes of all neonates who underwent a stage I reconstruction between January 1, 2002, and October 1, 2004, with use of the RV-PA conduit and modified Blalock-Taussig shunt (mBTS) interspersed over this time period.
In all, 149 infants underwent a stage I reconstruction (95 mBTS, 54 RV-PA) for hypoplastic left heart syndrome (HLHS) or variants. There was a preference for the RV-PA conduit in patients with aortic atresia (mBTS 30% versus RV-PA 67%, p < 0.01). There was no difference in surgical mortality (mBTS 14% versus RV-PA 17%, p = 0.67), time to extubation (mBTS 4.5 ± 4.8 days versus RV-PA 3.9 ± 3.5 days, p = 0.47), or length of hospital stay (mBTS 25 ± 29 days versus RV-PA 21 ± 23 days, p = 0.52). There was an increased incidence of shunt reinterventions in the patients with the RV-PA conduit (mBTS 17% versus RV-PA 32%, p = 0.04). Patients with RV-PA conduit returned earlier for stage II reconstruction (mBTS 6.5 ± 2.5 months versus RV-PA 5.6 ± 1.7 months, p = 0.05). There was no difference in overall mortality (mBTS 32% versus RV-PA 30%, p = 0.45) with a median duration of follow-up of 18 ± 8 months.
Comparing shunt strategies (mBTS versus RV-PA) over the same time period, we found no difference in outcome. These data support the need for a larger prospective, randomized trial.</abstract><cop>Netherlands</cop><pub>Elsevier Inc</pub><pmid>16242421</pmid><doi>10.1016/j.athoracsur.2005.04.046</doi><tpages>10</tpages><oa>free_for_read</oa></addata></record> |
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| source | MEDLINE; Elsevier ScienceDirect Journals; Elektronische Zeitschriftenbibliothek - Frei zugängliche E-Journals; Alma/SFX Local Collection |
| subjects | Arteriovenous Shunt, Surgical Humans Hypoplastic Left Heart Syndrome - mortality Hypoplastic Left Heart Syndrome - surgery Infant, Newborn Pulmonary Artery - surgery Retrospective Studies Risk Factors Survival Analysis |
| title | Outcomes After the Stage I Reconstruction Comparing the Right Ventricular to Pulmonary Artery Conduit With the Modified Blalock Taussig Shunt |
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