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Ann Thorac Surg 2005;80:1582-1591
© 2005 The Society of Thoracic Surgeons

J. Maxwell Chamberlain memorial paper

Outcomes After the Stage I Reconstruction Comparing the Right Ventricular to Pulmonary Artery Conduit With the Modified Blalock Taussig Shunt

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

Department of Pediatrics, Division of Cardiology, Department of Surgery, Division of Cardiothoracic Surgery, and Department of Anesthesiology and Critical Care Medicine, Children's Hospital of Philadelphia and University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania

Accepted for publication April 25, 2005.

* Address correspondence to Dr Tabbutt, Cardiac Intensive Care Unit, The Cardiac Center, Children's Hospital of Philadelphia, 34th St and Civic Center Blvd, Philadelphia, PA 19119 (Email: tabbutt{at}email.chop.edu).

Presented at the Forty-first Annual Meeting of The Society of Thoracic Surgeons, Tampa, FL, Jan 24–26, 2005. Winner of the J. Maxwell Chamberlain Memorial Award for Congenital Heart Disease.

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.




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