Second stage after initial hybrid palliation for hypoplastic left heart syndrome: Arterial or venous shunt?

Mohamed S. Nassar, Srinivas A. Narayan, Andrew Nyman, Caner Salih, Conal B. Austin, David Anderson, Tarique Hussain

Research output: Contribution to journalArticle

6 Citations (Scopus)

Abstract

Objective Hybrid palliation for hypoplastic left heart syndrome has been developed as an alternative to neonatal Norwood surgery. At the second stage, a source of pulmonary blood flow has to be established. Options include an arterial modified Blalock-Taussig or a venous superior cavopulmonary shunt. Methods We retrospectively reviewed patients who received second-stage palliation after the initial hybrid. Patients were stratified according to the source of pulmonary blood supply into the arterial shunt (n = 17 patients) or venous shunt (n = 26 patients). Results Age and weight at second stage were lower in the arterial group (85 [45-268] days vs 152.5 [61-496] days, P =.001 and 3.6 [2.7-9.4] kg vs 5.1 [2.97-9.4] kg, P =.001, respectively). All recorded surgical times were shorter in the arterial group. Mechanical ventilation and intensive care stay were shorter in the venous group (5.82 [2.01-14.9] days vs 2.42 [0.56-13.67] days, P =.005 and 8.5 [3.6-23.7] vs 5.75 [0.8-17.6] days, P =.036, respectively) There was no difference in mortality (2/17 vs 5/26; P =.685) or incidence of complications between the 2 groups. There was a tendency toward a higher need for intervention in the immediate postoperative period in the venous group, but this did not reach significance (6/17 vs 13/26, P =.342). The arterial group has shown better development of the branch pulmonary arteries with a higher lower lobe index (158.38 ± 39.43 mm2/m2 vs 113.33 ± 43.96 mm2/m2, respectively, P =.037). Conclusions Both arterial and venous shunts are viable options with mortality and morbidity results comparable to those in the literature. The arterial shunt pathway (2-stage Norwood I) may offer better pulmonary arterial growth than the venous shunt (comprehensive/combined Norwood I and II).

Original languageEnglish (US)
Pages (from-to)350-357
Number of pages8
JournalJournal of Thoracic and Cardiovascular Surgery
Volume150
Issue number2
DOIs
StatePublished - Jan 1 2015

Fingerprint

Hypoplastic Left Heart Syndrome
Lung
Right Heart Bypass
Mortality
Critical Care
Operative Time
Artificial Respiration
Postoperative Period
Pulmonary Artery
Morbidity
Weights and Measures
Incidence
Growth
aliflurane

Keywords

  • hybrid
  • Hypoplastic left heart syndrome
  • shunt

ASJC Scopus subject areas

  • Surgery
  • Pulmonary and Respiratory Medicine
  • Cardiology and Cardiovascular Medicine

Cite this

Second stage after initial hybrid palliation for hypoplastic left heart syndrome : Arterial or venous shunt? / Nassar, Mohamed S.; Narayan, Srinivas A.; Nyman, Andrew; Salih, Caner; Austin, Conal B.; Anderson, David; Hussain, Tarique.

In: Journal of Thoracic and Cardiovascular Surgery, Vol. 150, No. 2, 01.01.2015, p. 350-357.

Research output: Contribution to journalArticle

Nassar, Mohamed S. ; Narayan, Srinivas A. ; Nyman, Andrew ; Salih, Caner ; Austin, Conal B. ; Anderson, David ; Hussain, Tarique. / Second stage after initial hybrid palliation for hypoplastic left heart syndrome : Arterial or venous shunt?. In: Journal of Thoracic and Cardiovascular Surgery. 2015 ; Vol. 150, No. 2. pp. 350-357.
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T2 - Arterial or venous shunt?

AU - Nassar, Mohamed S.

AU - Narayan, Srinivas A.

AU - Nyman, Andrew

AU - Salih, Caner

AU - Austin, Conal B.

AU - Anderson, David

AU - Hussain, Tarique

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N2 - Objective Hybrid palliation for hypoplastic left heart syndrome has been developed as an alternative to neonatal Norwood surgery. At the second stage, a source of pulmonary blood flow has to be established. Options include an arterial modified Blalock-Taussig or a venous superior cavopulmonary shunt. Methods We retrospectively reviewed patients who received second-stage palliation after the initial hybrid. Patients were stratified according to the source of pulmonary blood supply into the arterial shunt (n = 17 patients) or venous shunt (n = 26 patients). Results Age and weight at second stage were lower in the arterial group (85 [45-268] days vs 152.5 [61-496] days, P =.001 and 3.6 [2.7-9.4] kg vs 5.1 [2.97-9.4] kg, P =.001, respectively). All recorded surgical times were shorter in the arterial group. Mechanical ventilation and intensive care stay were shorter in the venous group (5.82 [2.01-14.9] days vs 2.42 [0.56-13.67] days, P =.005 and 8.5 [3.6-23.7] vs 5.75 [0.8-17.6] days, P =.036, respectively) There was no difference in mortality (2/17 vs 5/26; P =.685) or incidence of complications between the 2 groups. There was a tendency toward a higher need for intervention in the immediate postoperative period in the venous group, but this did not reach significance (6/17 vs 13/26, P =.342). The arterial group has shown better development of the branch pulmonary arteries with a higher lower lobe index (158.38 ± 39.43 mm2/m2 vs 113.33 ± 43.96 mm2/m2, respectively, P =.037). Conclusions Both arterial and venous shunts are viable options with mortality and morbidity results comparable to those in the literature. The arterial shunt pathway (2-stage Norwood I) may offer better pulmonary arterial growth than the venous shunt (comprehensive/combined Norwood I and II).

AB - Objective Hybrid palliation for hypoplastic left heart syndrome has been developed as an alternative to neonatal Norwood surgery. At the second stage, a source of pulmonary blood flow has to be established. Options include an arterial modified Blalock-Taussig or a venous superior cavopulmonary shunt. Methods We retrospectively reviewed patients who received second-stage palliation after the initial hybrid. Patients were stratified according to the source of pulmonary blood supply into the arterial shunt (n = 17 patients) or venous shunt (n = 26 patients). Results Age and weight at second stage were lower in the arterial group (85 [45-268] days vs 152.5 [61-496] days, P =.001 and 3.6 [2.7-9.4] kg vs 5.1 [2.97-9.4] kg, P =.001, respectively). All recorded surgical times were shorter in the arterial group. Mechanical ventilation and intensive care stay were shorter in the venous group (5.82 [2.01-14.9] days vs 2.42 [0.56-13.67] days, P =.005 and 8.5 [3.6-23.7] vs 5.75 [0.8-17.6] days, P =.036, respectively) There was no difference in mortality (2/17 vs 5/26; P =.685) or incidence of complications between the 2 groups. There was a tendency toward a higher need for intervention in the immediate postoperative period in the venous group, but this did not reach significance (6/17 vs 13/26, P =.342). The arterial group has shown better development of the branch pulmonary arteries with a higher lower lobe index (158.38 ± 39.43 mm2/m2 vs 113.33 ± 43.96 mm2/m2, respectively, P =.037). Conclusions Both arterial and venous shunts are viable options with mortality and morbidity results comparable to those in the literature. The arterial shunt pathway (2-stage Norwood I) may offer better pulmonary arterial growth than the venous shunt (comprehensive/combined Norwood I and II).

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