Impact of pre-stage II hemodynamics and pulmonary artery anatomy on 12-month outcomes in the Pediatric Heart Network Single Ventricle Reconstruction trial

Ranjit Aiyagari; John F. Rhodes; Peter Shrader; Wolfgang A. Radtke; Varsha M. Bandisode; Lisa Bergersen; Matthew J. Gillespie; Robert G. Gray; Lin T. Guey; Kevin D. Hill; Russel Hirsch; Dennis W. Kim; Kyong Jin Lee; Andrew N. Pelech; Jeremy Ringewald; Cheryl Takao; Julie A. Vincent; Richard G. Ohye

doi:10.1016/j.jtcvs.2013.10.057

Impact of pre-stage II hemodynamics and pulmonary artery anatomy on 12-month outcomes in the Pediatric Heart Network Single Ventricle Reconstruction trial

Ranjit Aiyagari^*, John F. Rhodes, Peter Shrader, Wolfgang A. Radtke, Varsha M. Bandisode, Lisa Bergersen, Matthew J. Gillespie, Robert G. Gray, Lin T. Guey, Kevin D. Hill, Russel Hirsch, Dennis W. Kim, Kyong Jin Lee, Andrew N. Pelech, Jeremy Ringewald, Cheryl Takao, Julie A. Vincent, Richard G. Ohye

^*Corresponding author for this work

Pediatrics

Research output: Contribution to journal › Article › peer-review

25 Scopus citations

Abstract

Objective: To compare the interstage cardiac catheterization hemodynamic and angiographic findings between shunt types for the Pediatric Heart Network Single Ventricle Reconstruction trial. The trial, which randomized subjects to a modified Blalock-Taussig shunt (MBTS) or right ventricle-to-pulmonary artery shunt (RVPAS) for the Norwood procedure, demonstrated the RVPAS was associated with a smaller pulmonary artery diameter but superior 12-month transplant-free survival.

Methods: We analyzed the pre-stage II catheterization data for the trial subjects. The hemodynamic variables and shunt and pulmonary angiographic data were compared between shunt types; their association with 12-month transplant-free survival was also evaluated.

Results: Of 549 randomized subjects, 389 underwent pre-stage II catheterization. A smaller size, lower aortic and superior vena cava saturation, and higher ventricular end-diastolic pressure were associated with worse 12- month transplant-free survival. The MBTS group had a lower coronary perfusion pressure (27 vs 32 mm Hg; P.001) and greater pulmonary blood flow/systemic blood flow ratio (1.1 vs 1.0, P = .009). A greater pulmonary blood flow/systemic blood flow ratio increased the risk of death or transplantation only in the RVPAS group (P=.01). The MBTS group had fewer shunt (14%vs 28%, P=.004) and severe left pulmonary artery (0.7%vs 9.2%, P = .003) stenoses, larger mid-main branch pulmonary artery diameters, and greater Nakata indexes (164 vs 134, P < .001).

Conclusions: Compared with the RVPAS subjects, the MBTS subjects had more hemodynamic abnormalities related to shunt physiology, and the RVPAS subjects had more shunt or pulmonary obstruction of a severe degree and inferior pulmonary artery growth at pre-stage II catheterization. A lower body surface area, greater ventricular end-diastolic pressure, and lower superior vena cava saturation were associated with worse 12-month transplant-free survival.

Original language	English (US)
Pages (from-to)	1467-1474
Number of pages	8
Journal	Journal of Thoracic and Cardiovascular Surgery
Volume	148
Issue number	4
DOIs	https://doi.org/10.1016/j.jtcvs.2013.10.057
State	Published - Oct 1 2014

Funding

This study was supported by U01 grants from the National Heart, Lung, and Blood Institute (grants HL068269 , HL068270 , HL068279 , HL068281 , HL068285 , HL068292 , HL068290 , HL068288 , HL085057 , HL109781 , and HL109737 ).

ASJC Scopus subject areas

Cardiology and Cardiovascular Medicine
Pulmonary and Respiratory Medicine
Surgery

UN SDGs

This output contributes to the following UN Sustainable Development Goals (SDGs)

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10.1016/j.jtcvs.2013.10.057

Cite this

Aiyagari, R., Rhodes, J. F., Shrader, P., Radtke, W. A., Bandisode, V. M., Bergersen, L., Gillespie, M. J., Gray, R. G., Guey, L. T., Hill, K. D., Hirsch, R., Kim, D. W., Lee, K. J., Pelech, A. N., Ringewald, J., Takao, C., Vincent, J. A., & Ohye, R. G. (2014). Impact of pre-stage II hemodynamics and pulmonary artery anatomy on 12-month outcomes in the Pediatric Heart Network Single Ventricle Reconstruction trial. Journal of Thoracic and Cardiovascular Surgery, 148(4), 1467-1474. https://doi.org/10.1016/j.jtcvs.2013.10.057

@article{923b67678bab4c549df1bc679c56324a,

title = "Impact of pre-stage II hemodynamics and pulmonary artery anatomy on 12-month outcomes in the Pediatric Heart Network Single Ventricle Reconstruction trial",

abstract = "Objective: To compare the interstage cardiac catheterization hemodynamic and angiographic findings between shunt types for the Pediatric Heart Network Single Ventricle Reconstruction trial. The trial, which randomized subjects to a modified Blalock-Taussig shunt (MBTS) or right ventricle-to-pulmonary artery shunt (RVPAS) for the Norwood procedure, demonstrated the RVPAS was associated with a smaller pulmonary artery diameter but superior 12-month transplant-free survival.Methods: We analyzed the pre-stage II catheterization data for the trial subjects. The hemodynamic variables and shunt and pulmonary angiographic data were compared between shunt types; their association with 12-month transplant-free survival was also evaluated.Results: Of 549 randomized subjects, 389 underwent pre-stage II catheterization. A smaller size, lower aortic and superior vena cava saturation, and higher ventricular end-diastolic pressure were associated with worse 12- month transplant-free survival. The MBTS group had a lower coronary perfusion pressure (27 vs 32 mm Hg; P.001) and greater pulmonary blood flow/systemic blood flow ratio (1.1 vs 1.0, P = .009). A greater pulmonary blood flow/systemic blood flow ratio increased the risk of death or transplantation only in the RVPAS group (P=.01). The MBTS group had fewer shunt (14%vs 28%, P=.004) and severe left pulmonary artery (0.7%vs 9.2%, P = .003) stenoses, larger mid-main branch pulmonary artery diameters, and greater Nakata indexes (164 vs 134, P < .001).Conclusions: Compared with the RVPAS subjects, the MBTS subjects had more hemodynamic abnormalities related to shunt physiology, and the RVPAS subjects had more shunt or pulmonary obstruction of a severe degree and inferior pulmonary artery growth at pre-stage II catheterization. A lower body surface area, greater ventricular end-diastolic pressure, and lower superior vena cava saturation were associated with worse 12-month transplant-free survival.",

author = "Ranjit Aiyagari and Rhodes, {John F.} and Peter Shrader and Radtke, {Wolfgang A.} and Bandisode, {Varsha M.} and Lisa Bergersen and Gillespie, {Matthew J.} and Gray, {Robert G.} and Guey, {Lin T.} and Hill, {Kevin D.} and Russel Hirsch and Kim, {Dennis W.} and Lee, {Kyong Jin} and Pelech, {Andrew N.} and Jeremy Ringewald and Cheryl Takao and Vincent, {Julie A.} and Ohye, {Richard G.}",

note = "Publisher Copyright: {\textcopyright} 2014 The American Association for Thoracic Surgery.",

year = "2014",

month = oct,

day = "1",

doi = "10.1016/j.jtcvs.2013.10.057",

language = "English (US)",

volume = "148",

pages = "1467--1474",

journal = "Journal of Thoracic and Cardiovascular Surgery",

issn = "0022-5223",

publisher = "Elsevier Inc.",

number = "4",

}

Aiyagari, R, Rhodes, JF, Shrader, P, Radtke, WA, Bandisode, VM, Bergersen, L, Gillespie, MJ, Gray, RG, Guey, LT, Hill, KD, Hirsch, R, Kim, DW, Lee, KJ, Pelech, AN, Ringewald, J, Takao, C, Vincent, JA & Ohye, RG 2014, 'Impact of pre-stage II hemodynamics and pulmonary artery anatomy on 12-month outcomes in the Pediatric Heart Network Single Ventricle Reconstruction trial', Journal of Thoracic and Cardiovascular Surgery, vol. 148, no. 4, pp. 1467-1474. https://doi.org/10.1016/j.jtcvs.2013.10.057

Impact of pre-stage II hemodynamics and pulmonary artery anatomy on 12-month outcomes in the Pediatric Heart Network Single Ventricle Reconstruction trial. / Aiyagari, Ranjit; Rhodes, John F.; Shrader, Peter et al.
In: Journal of Thoracic and Cardiovascular Surgery, Vol. 148, No. 4, 01.10.2014, p. 1467-1474.

Research output: Contribution to journal › Article › peer-review

TY - JOUR

T1 - Impact of pre-stage II hemodynamics and pulmonary artery anatomy on 12-month outcomes in the Pediatric Heart Network Single Ventricle Reconstruction trial

AU - Aiyagari, Ranjit

AU - Rhodes, John F.

AU - Shrader, Peter

AU - Radtke, Wolfgang A.

AU - Bandisode, Varsha M.

AU - Bergersen, Lisa

AU - Gillespie, Matthew J.

AU - Gray, Robert G.

AU - Guey, Lin T.

AU - Hill, Kevin D.

AU - Hirsch, Russel

AU - Kim, Dennis W.

AU - Lee, Kyong Jin

AU - Pelech, Andrew N.

AU - Ringewald, Jeremy

AU - Takao, Cheryl

AU - Vincent, Julie A.

AU - Ohye, Richard G.

PY - 2014/10/1

Y1 - 2014/10/1

N2 - Objective: To compare the interstage cardiac catheterization hemodynamic and angiographic findings between shunt types for the Pediatric Heart Network Single Ventricle Reconstruction trial. The trial, which randomized subjects to a modified Blalock-Taussig shunt (MBTS) or right ventricle-to-pulmonary artery shunt (RVPAS) for the Norwood procedure, demonstrated the RVPAS was associated with a smaller pulmonary artery diameter but superior 12-month transplant-free survival.Methods: We analyzed the pre-stage II catheterization data for the trial subjects. The hemodynamic variables and shunt and pulmonary angiographic data were compared between shunt types; their association with 12-month transplant-free survival was also evaluated.Results: Of 549 randomized subjects, 389 underwent pre-stage II catheterization. A smaller size, lower aortic and superior vena cava saturation, and higher ventricular end-diastolic pressure were associated with worse 12- month transplant-free survival. The MBTS group had a lower coronary perfusion pressure (27 vs 32 mm Hg; P.001) and greater pulmonary blood flow/systemic blood flow ratio (1.1 vs 1.0, P = .009). A greater pulmonary blood flow/systemic blood flow ratio increased the risk of death or transplantation only in the RVPAS group (P=.01). The MBTS group had fewer shunt (14%vs 28%, P=.004) and severe left pulmonary artery (0.7%vs 9.2%, P = .003) stenoses, larger mid-main branch pulmonary artery diameters, and greater Nakata indexes (164 vs 134, P < .001).Conclusions: Compared with the RVPAS subjects, the MBTS subjects had more hemodynamic abnormalities related to shunt physiology, and the RVPAS subjects had more shunt or pulmonary obstruction of a severe degree and inferior pulmonary artery growth at pre-stage II catheterization. A lower body surface area, greater ventricular end-diastolic pressure, and lower superior vena cava saturation were associated with worse 12-month transplant-free survival.

AB - Objective: To compare the interstage cardiac catheterization hemodynamic and angiographic findings between shunt types for the Pediatric Heart Network Single Ventricle Reconstruction trial. The trial, which randomized subjects to a modified Blalock-Taussig shunt (MBTS) or right ventricle-to-pulmonary artery shunt (RVPAS) for the Norwood procedure, demonstrated the RVPAS was associated with a smaller pulmonary artery diameter but superior 12-month transplant-free survival.Methods: We analyzed the pre-stage II catheterization data for the trial subjects. The hemodynamic variables and shunt and pulmonary angiographic data were compared between shunt types; their association with 12-month transplant-free survival was also evaluated.Results: Of 549 randomized subjects, 389 underwent pre-stage II catheterization. A smaller size, lower aortic and superior vena cava saturation, and higher ventricular end-diastolic pressure were associated with worse 12- month transplant-free survival. The MBTS group had a lower coronary perfusion pressure (27 vs 32 mm Hg; P.001) and greater pulmonary blood flow/systemic blood flow ratio (1.1 vs 1.0, P = .009). A greater pulmonary blood flow/systemic blood flow ratio increased the risk of death or transplantation only in the RVPAS group (P=.01). The MBTS group had fewer shunt (14%vs 28%, P=.004) and severe left pulmonary artery (0.7%vs 9.2%, P = .003) stenoses, larger mid-main branch pulmonary artery diameters, and greater Nakata indexes (164 vs 134, P < .001).Conclusions: Compared with the RVPAS subjects, the MBTS subjects had more hemodynamic abnormalities related to shunt physiology, and the RVPAS subjects had more shunt or pulmonary obstruction of a severe degree and inferior pulmonary artery growth at pre-stage II catheterization. A lower body surface area, greater ventricular end-diastolic pressure, and lower superior vena cava saturation were associated with worse 12-month transplant-free survival.

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UR - http://www.scopus.com/inward/citedby.url?scp=84908236610&partnerID=8YFLogxK

U2 - 10.1016/j.jtcvs.2013.10.057

DO - 10.1016/j.jtcvs.2013.10.057

M3 - Article

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AN - SCOPUS:84908236610

SN - 0022-5223

VL - 148

SP - 1467

EP - 1474

JO - Journal of Thoracic and Cardiovascular Surgery

JF - Journal of Thoracic and Cardiovascular Surgery

IS - 4

ER -

Impact of pre-stage II hemodynamics and pulmonary artery anatomy on 12-month outcomes in the Pediatric Heart Network Single Ventricle Reconstruction trial

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UN SDGs

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