James R Bentham1, Christopher W Baird2, Deigo P Porras1, Rahul H Rathod1, Audrey C Marshall3. 1. Department of Cardiology, Boston Children's Hospital, and Department of Pediatrics, Harvard Medical School, Boston, Mass. 2. Department of Cardiac Surgery, Boston Children's Hospital, and Department of Surgery, Harvard Medical School, Boston, Mass. 3. Department of Cardiology, Boston Children's Hospital, and Department of Pediatrics, Harvard Medical School, Boston, Mass. Electronic address: audrey.marshall@cardio.chboston.org.
Abstract
OBJECTIVE: To compare early postoperative outcomes, angiographic, and intervention findings and 1-year survival between 2 groups of infant patients: those receiving a standard right-ventricle-to-pulmonary-artery (RV-PA) conduit versus a ring-reinforced RV-PA conduit, in undergoing Norwood stage-1 surgery for hypoplastic left heart syndrome (HLHS). The technique of using such a ring-reinforced graft, placed through a limited ventriculotomy, has theoretic advantages in preserving right ventricular function, compared with the standard technique of RV-PA conduit creation. METHODS: This retrospective cohort study was performed between July 2006 and July 2013. A total of 87 patients with HLHS underwent Norwood stage-1 surgery during this period; 48 received a standard nonreinforced RV-PA conduit; 39 received a ring-reinforced conduit. Primary and secondary outcomes were survival and need for cardiac reintervention up to age 12 months. RESULTS: No difference was found in transplant-free survival by age 12 months (87% ring-reinforced vs 73% nonreinforced, P = .12). The group with the nonreinforced, versus ring-reinforced, grafts had more interventions in the first year (69% vs 35%, respectively; P < .01). Before stage 2, the pulmonary artery pulse pressure was greater in the group with ring-reinforced grafts (9.1 ± 4.1 vs 4.8 ± 3.1 mm Hg, P < .001), with no difference in mean pressure (15.2 ± 3.32 vs 14.3 ± 3.48 mm Hg, P = .27). The corrected pulmonary artery index (Nakata) was greater in the group with ring-reinforced grafts (213 ± 76 vs 134 ± 68 mm(2)/m(2), P < .0001). CONCLUSIONS: A ring-reinforced conduit is associated with reduced intervention, as well as higher pulse pressures and improved pulmonary artery growth, in infants undergoing stage-1 palliation for HLHS.
OBJECTIVE: To compare early postoperative outcomes, angiographic, and intervention findings and 1-year survival between 2 groups of infantpatients: those receiving a standard right-ventricle-to-pulmonary-artery (RV-PA) conduit versus a ring-reinforced RV-PA conduit, in undergoing Norwood stage-1 surgery for hypoplastic left heart syndrome (HLHS). The technique of using such a ring-reinforced graft, placed through a limited ventriculotomy, has theoretic advantages in preserving right ventricular function, compared with the standard technique of RV-PA conduit creation. METHODS: This retrospective cohort study was performed between July 2006 and July 2013. A total of 87 patients with HLHS underwent Norwood stage-1 surgery during this period; 48 received a standard nonreinforced RV-PA conduit; 39 received a ring-reinforced conduit. Primary and secondary outcomes were survival and need for cardiac reintervention up to age 12 months. RESULTS: No difference was found in transplant-free survival by age 12 months (87% ring-reinforced vs 73% nonreinforced, P = .12). The group with the nonreinforced, versus ring-reinforced, grafts had more interventions in the first year (69% vs 35%, respectively; P < .01). Before stage 2, the pulmonary artery pulse pressure was greater in the group with ring-reinforced grafts (9.1 ± 4.1 vs 4.8 ± 3.1 mm Hg, P < .001), with no difference in mean pressure (15.2 ± 3.32 vs 14.3 ± 3.48 mm Hg, P = .27). The corrected pulmonary artery index (Nakata) was greater in the group with ring-reinforced grafts (213 ± 76 vs 134 ± 68 mm(2)/m(2), P < .0001). CONCLUSIONS: A ring-reinforced conduit is associated with reduced intervention, as well as higher pulse pressures and improved pulmonary artery growth, in infants undergoing stage-1 palliation for HLHS.
Authors: Jane W Newburger; Lynn A Sleeper; J William Gaynor; Danielle Hollenbeck-Pringle; Peter C Frommelt; Jennifer S Li; William T Mahle; Ismee A Williams; Andrew M Atz; Kristin M Burns; Shan Chen; James Cnota; Carolyn Dunbar-Masterson; Nancy S Ghanayem; Caren S Goldberg; Jeffrey P Jacobs; Alan B Lewis; Seema Mital; Christian Pizarro; Aaron Eckhauser; Paul Stark; Richard G Ohye Journal: Circulation Date: 2018-02-01 Impact factor: 29.690
Authors: Puneet Bhatla; Tk Susheel Kumar; Luv Makadia; Brandon Winston; Catherine Bull; James C Nielsen; David Williams; Sujata Chakravarti; Richard G Ohye; Ralph S Mosca Journal: JTCVS Tech Date: 2021-05-21