The importance of age and weight on cavopulmonary shunt (stage II) outcomes after the Norwood procedure: Planned versus unplanned surgery

Barron, David J.; Haq, Intisar Ul; Crucean, Adrian; Stickley, John; Botha, Phil; Khan, Natasha; Jones, Timothy J.; Brawn, William J.

doi:10.1016/j.jtcvs.2016.12.036

Cited by 22 publications

(12 citation statements)

References 23 publications

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“…In low/intermediate-risk patients, maximal survival was associated with proceeding to S2P after age 3 months. Our results are in accordance of a study of unplanned vs. planned S2P, which advocated performing elective S2P at age 4 months, though that analysis did not account for pre-S2P attrition (19).…”

Section: Commentsupporting

confidence: 89%

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The Optimal Timing of Stage-2-Palliation After the Norwood Operation

Meza

Hickey

McCrindle

et al. 2018

The Annals of Thoracic Surgery

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Section: Commentsupporting

confidence: 89%

“…Two recent investigations have described that age <3 months at S2P is associated with death or heart transplantation and in-hospital mortality, respectively (17, 18). The recent study by Barron and colleagues is a notable except, as no association between age at S2P and death/heart transplantation in 297 infants (19).…”

Section: Commentmentioning

confidence: 98%

The Optimal Timing of Stage-2-Palliation After the Norwood Operation

Meza

Hickey

McCrindle

et al. 2018

The Annals of Thoracic Surgery

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“…Another concern about age is the success of cava-pulmonary connection in young patients. Barron et al 23 on 297 Hypoplastic Left Heart Syndrome (HLHS) patients demonstrate that 3 months of age was safe for bidirectional Glenn anastomosis, whereas poor somatic growth is a risk factor. According to that data, our cava-pulmonary shunt group was in safe limits for age and has a better somatic growth than Blalock Taussig shunt group.…”

Section: Discussionmentioning

confidence: 99%

Pulmonary artery banding and venous bidirectional cava-pulmonary shunt for two-stage arterial switch procedure in late referral of patients with transposition of the great arteries and intact ventricular septum: midterm results

et al. 2019

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Objective:Two-stage arterial switch operation and left ventricle retraining are necessary for the patients with left ventricle dysfunction and transposition of great vessels with intact ventricular septum (TGA-IVS) who are referred late.Material and methods:Forty-seven patients with the diagnosis of TGA-IVS and left ventricle dysfunction who underwent arterial switch operation in our centre between July 2013 and August 2017 were analysed retrospectively. The inclusion criteria for left ventricle retraining were patients older than 2 months of age at presentation, having an echocardiographic left ventricle mass index of less than 35 g/m², and having an echocardiographic “banana-shaped” left ventricle geometric appearance. The patients were divided into two groups: pulmonary artery banding and Blalock Taussig shunt were performed as the initial surgical procedure for later arterial switch operation in Group I (n = 19) and pulmonary artery banding and bidirectional cava-pulmonary shunt in Group 2 (n = 28).Results:The average age was found to be 122.3 ± 45.6 days in Group I and 145.9 ± 37.2 days in Group II. There was no statistically significant difference (p = 0.232 versus p = 0.373) between the average left ventricle mass index of the two groups neither before the first stage nor the second stage (26.6 ± 4.8 g/m² versus 25.0 ± 4.9 g/m² and 70.5 ± 12 g/m² versus 673.8 ± 12.0 g/m², respectively). The average time interval for the left ventricle to retrain was 97.7 ± 42.9 days for Group I and 117.3 ± 40.3 days for Group II, significantly lower in Group I (p = 0.027). The time spent in ICU, length of the period during which inotropic support was required, and the duration of hospital stay were significantly higher in Group I (p<0.001, p < 0.001, and p < 0.00, respectively).Conclusion:Pulmonary artery banding and bidirectional cava-pulmonary shunt can be performed as a safe and effective alternative to pulmonary artery banding and arterial Blalock Taussig shunt for patients with TGA-IVS in whom arterial switch operation is needed beyond the neonatal period. This approach involves a shorter hospital stay and fewer post-operative complications.

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“…A growing list of risk factors for complications, lengths of stay, and transplant-free and overall survival after second-stage palliation has accumulated over the past decade (Table 1). [42][43][44][45][46][47][48][49][50][51] This list includes many patient factors as well as factors related to either stage I or II procedure and management. While it is difficult to systematically compare the weight of each factor, those most commonly cited from these studies include atrioventricular valve regurgitation (>mild), ventricular dysfunction, need for reintervention, and failure to attain nutritional and/or growth goals.…”

Section: Risk Factorsmentioning

confidence: 99%

The Superior Cavopulmonary Connection: History and Current Perspectives

Herrmann

Brown

2019

World J Pediatr Congenit Heart Surg

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The development of the superior cavopulmonary connection is a rich illustration of international influences in congenital cardiac surgery. The bidirectional Glenn and hemi-Fontan procedures have improved survival as both definitive and staged functional single ventricle palliation. The optimal timing of the second-stage superior cavopulmonary procedures varies by center but for low-and intermediate-risk patients, this may be within three to six months after the Norwood procedure. The list of risk factors continues to grow but the most frequently cited factors include atrioventricular valve regurgitation, decreased ventricular function, need for reintervention, and failure to attain nutritional and growth goals. Ongoing prospective, multi-institutional studies, particularly those fostered internationally by the World Society for Pediatric and Congenital Heart Surgery and other associations, will hopefully provide further clarification of the complex management issues related to patients with functional single ventricle physiology.

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The importance of age and weight on cavopulmonary shunt (stage II) outcomes after the Norwood procedure: Planned versus unplanned surgery

Cited by 22 publications

References 23 publications

The Optimal Timing of Stage-2-Palliation After the Norwood Operation

The Optimal Timing of Stage-2-Palliation After the Norwood Operation

Pulmonary artery banding and venous bidirectional cava-pulmonary shunt for two-stage arterial switch procedure in late referral of patients with transposition of the great arteries and intact ventricular septum: midterm results

The Superior Cavopulmonary Connection: History and Current Perspectives

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