Travis J Wilder1, Brian W McCrindle2, Alistair B Phillips3, Eugene H Blackstone4, Jeevanantham Rajeswaran4, William G Williams1, William M DeCampli5, Jeffrey P Jacobs6, Marshall L Jacobs7, Tara Karamlou8, Paul M Kirshbom9, Gary K Lofland10, Gerhard Ziemer11, Edward J Hickey12. 1. Congenital Heart Surgeons' Society Data Center, The Hospital for Sick Children, Toronto, Canada. 2. Division of Pediatric Cardiology, Department of Pediatrics, University of Toronto, and The Hospital for Sick Children, Toronto, Canada. 3. Department of Surgery, Division of Cardiothoracic Surgery, Cedars-Sinai Medical Center, Los Angeles, Calif. 4. Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio. 5. Department of Cardiothoracic Surgery, Arnold Palmer Hospital for Children, Orlando, Fla. 6. Division of Cardiac Surgery, Department of Surgery, All Children's Hospital, Johns Hopkins University School of Medicine, Baltimore, Md. 7. Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Md. 8. Division of Pediatric Cardiac Surgery, Benioff Children's Hospital, University of California San Francisco, San Francisco, Calif. 9. Division of Cardiothoracic Surgery, Connecticut Children's Medical Center, Hartford; and Yale-New Haven Children's Hospital, New Haven, Conn. 10. University of Missouri-Kansas City, Kansas City, Mo. 11. Department of Surgery, Division of Cardiac & Thoracic Surgery, University of Chicago School of Medicine, Chicago, Ill. 12. Department of Cardiovascular Surgery, University of Toronto, and The Hospital for Sick Children, Toronto, Ontario, Canada. Electronic address: edward.hickey@sickkids.ca.
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.
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-RVPApatients with 169 NW-BTpatients. 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.
Authors: James M Meza; Edward Hickey; Brian McCrindle; Eugene Blackstone; Brett Anderson; David Overman; James K Kirklin; Tara Karamlou; Christopher Caldarone; Richard Kim; William DeCampli; Marshall Jacobs; Kristine Guleserian; Jeffrey P Jacobs; Robert Jaquiss Journal: Ann Thorac Surg Date: 2017-08-25 Impact factor: 4.330
Authors: Emilie Jean-St-Michel; James M Meza; Jonathon Maguire; John Coles; Brian W McCrindle Journal: Pediatr Cardiol Date: 2018-03-08 Impact factor: 1.655
Authors: Katrin Fricke; Mats Mellander; Katarina Hanséus; Phan-Kiet Tran; Mats Synnergren; Jens Johansson Ramgren; Annika Rydberg; Jan Sunnegårdh; Magnus Dalén; Gunnar Sjöberg; Constance G Weismann; Petru Liuba Journal: J Am Heart Assoc Date: 2022-03-29 Impact factor: 6.106