Outcomes after the stage I reconstruction comparing the right ventricular to pulmonary artery conduit with the modified Blalock Taussig shunt

Sarah Tabbutt*, Troy E. Dominguez, Chitra Ravishankar, Bradley S. Marino, Peter J. Gruber, Gil Wernovsky, J. William Gaynor, Susan C. Nicolson, Thomas L. Spray

*Corresponding author for this work

Research output: Contribution to journalArticle

140 Scopus citations

Abstract

Background. Recent reports advocate that a right ventricular to pulmonary artery (RV-PA) conduit improves outcome after the stage I reconstruction. Methods. 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. Results. 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. Conclusions. 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.

Original languageEnglish (US)
Pages (from-to)1582-1591
Number of pages10
JournalAnnals of Thoracic Surgery
Volume80
Issue number5
DOIs
StatePublished - Nov 1 2005

ASJC Scopus subject areas

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

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    Tabbutt, S., Dominguez, T. E., Ravishankar, C., Marino, B. S., Gruber, P. J., Wernovsky, G., Gaynor, J. W., Nicolson, S. C., & Spray, T. L. (2005). Outcomes after the stage I reconstruction comparing the right ventricular to pulmonary artery conduit with the modified Blalock Taussig shunt. Annals of Thoracic Surgery, 80(5), 1582-1591. https://doi.org/10.1016/j.athoracsur.2005.04.046