Survival and right ventricular performance for matched children after stage-1 Norwood: Modified Blalock-Taussig shunt versus right-ventricle-to-pulmonary-artery conduit.

Content Provider	Semantic Scholar
Author	Wilder, Travis J. McCrindle, Brian W. Phillips, Alistair B. M. Blackstone, Eugene H. Rajeswaran, Jeevanantham Williams, William G. DeCampli, William M. Jacobs, Jeffrey Phillip Jacobs, Marshall L. Karamlou, Tara Kirshbom, Paul M. Lofland, Gary K. Ziemer, Gerhard Hickey, Edward J.
Copyright Year	2015
Abstract	OBJECTIVE Early survival advantages after Norwood with right-ventricle-(RV)-to-pulmonary-artery conduit (NW-RVPA) over Norwood-operation with a Blalock-Taussig shunt (NW-BT) are offset by concerns regarding delayed RV dysfunction. We compared trends in survival, RV dysfunction, and tricuspid valve regurgitation (TR) between NW-RVPA and NW-BT for propensity-matched neonates with critical left ventricular outflow tract obstruction (LVOTO). METHODS In an inception cohort (2005-2014; 21 institutions), 454 neonates with critical LVOTO underwent Norwood stage 1. Propensity-score matching paired 169 NW-RVPA patients with 169 NW-BT patients. End-states were compared between NW-RVPA and NW-BT using competing-risks, multiphase, parametric, hazard analysis. Post-Norwood echocardiogram reports (n = 2993) were used to grade RV dysfunction and TR. Time-related prevalence of ≥moderate RV dysfunction and TR were characterized using nonlinear mixed-model regression, and compared between groups via multiphase, parametric models. RESULTS Overall 6-year survival was better after NW-RVPA (70%) versus NW-BT (55%; P < .001). Additionally, transplant-free survival during this time was better after NW-RVPA (64%) versus NW-BT (53%; P = .004). Overall prevalence of ≥moderate RV dysfunction reached 11% within 3 months post-Norwood. During this time, RV dysfunction after NW-BT was 16% versus 6% after NW-RVPA (P = .02), and coincided temporally with an increased early hazard for death. For survivors, late RV dysfunction was <5% and was not different between groups (P = .36). Overall prevalence of ≥moderate TR reached 13% at 2 years post-Norwood and was increased after NW-BT (16%) versus NW-RVPA (11%; P = .003). Late TR was similar between groups. CONCLUSIONS Among propensity-score-matched neonates with critical LVOTO, NW-RVPA offers superior 6-year survival with no greater prevalence of RV dysfunction or TR than conventional NW-BT operations.
File Format	PDF HTM / HTML
DOI	10.1016/j.jtcvs.2015.06.069
Alternate Webpage(s)	http://www.chssdc.org/sites/default/files/2015_Wilder_JTCVS_LVOTO.pdf
PubMed reference number	26254760
Alternate Webpage(s)	https://doi.org/10.1016/j.jtcvs.2015.06.069
Journal	Medline
Volume Number	150
Issue Number	6
Journal	The Journal of thoracic and cardiovascular surgery
Language	English
Access Restriction	Open
Content Type	Text
Resource Type	Article