Department of Congenital and Pediatric Heart Surgery, German Heart Center Munich, Technische Universität München, Munich, Germany.
Division of Congenital and Pediatric Heart Surgery, University Hospital of Munich, Ludwig-Maximilians-Universität, Munich, Germany.
Eur J Cardiothorac Surg. 2021 Nov 2;60(5):1084-1091. doi: 10.1093/ejcts/ezab163.
The ideal shunt for pulmonary blood flow, modified Blalock-Taussig shunt (MBTS) or right ventricular-pulmonary artery conduit (RVPAC) is yet to be determined. This study aimed to evaluate outcomes after the Norwood procedure according to the type of shunt.
A total of 322 neonates with hypoplastic left heart syndrome and related anomalies who underwent the Norwood procedure at our institution between 2001 and 2019 were divided into MBTS and RVPAC groups and the outcomes after the Norwood procedure were compared between the groups with respect to mortality after each staged procedure.
We identified 322 consequent patients who underwent neonatal Norwood procedure for hypoplastic left heart syndrome (271 patients, 84.2%) and its variant (51 patients, 15.8%). RVPAC was performed in 163 (50.6%) patients and MBTS was performed in 159 (49.4%). There were no differences in the rate of early death (11.0% vs 12.6%, P = 0.69) or late death (7.4% vs 6.9%, P = 0.87) between the 2 groups after the Norwood procedure, and no significant difference in the number of patients who reached bidirectional cavopulmonary shunt (77.9% vs 76.1%, P = 0.69), and there was no difference in mortality after bidirectional cavopulmonary shunt (12.3% vs 7.5%, P = 0.15) or Fontan completion rate (54.0% vs 52.2%, P = 0.42) between the 2 groups. Survival at 0.5, 1, 3 and 6 years after the Norwood procedure was 81.0%, 73.8%, 67.9% and 67.0% in patients with RVPAC and 77.1%, 73.3%, 69.1% and 67.9% in patients with MBTS. There was no significant difference in the survival between the 2 groups during the median follow-up of 2.6 (interquartile ranges: 0.3-8.4, maximal 18.8) years (P = 0.97).
In neonates undergoing the Norwood procedure, our available data of maximal 18.8 years follow-up showed no significant difference in early mortality, inter-stage attritions, or overall survival, between MBTS and RVPAC.
改良的 Blalock-Taussig 分流术（MBTS）或右心室-肺动脉导管（RVPAC）作为肺血流分流术的理想选择尚未确定。本研究旨在根据分流术类型评估 Norwood 手术后的结局。
本研究纳入了 2001 年至 2019 年期间在我院接受 Norwood 手术的 322 例左心发育不全综合征合并相关畸形的新生儿，将其分为 MBTS 组和 RVPAC 组，比较两组 Norwood 手术后各阶段死亡率。
共纳入 322 例左心发育不全综合征患儿（271 例，84.2%）及其变异型（51 例，15.8%）接受 Norwood 手术，其中 163 例（50.6%）患儿行 RVPAC，159 例（49.4%）患儿行 MBTS。两组 Norwood 手术后早期死亡率（11.0% vs 12.6%，P=0.69）和晚期死亡率（7.4% vs 6.9%，P=0.87）无差异，达到双向腔静脉肺动脉吻合术（BCPS）的患者比例（77.9% vs 76.1%，P=0.69）和 BCPS 术后死亡率（12.3% vs 7.5%，P=0.15）无差异，Fontan 完成率（54.0% vs 52.2%，P=0.42）也无差异。RVPAC 组患者 Norwood 手术后 0.5、1、3 和 6 年的生存率分别为 81.0%、73.8%、67.9%和 67.0%，MBTS 组患者分别为 77.1%、73.3%、69.1%和 67.9%。两组中位随访 2.6（四分位距：0.3-8.4，最长 18.8）年的生存率差异无统计学意义（P=0.97）。
在接受 Norwood 手术的新生儿中，我们最长 18.8 年的随访数据显示，MBTS 和 RVPAC 之间的早期死亡率、各阶段死亡率和总生存率无显著差异。
