Norwood procedure for hypoplastic left heart syndrome: BT shunt or RV-PA conduit?
BACKGROUND
The Norwood procedure is the first stage palliative procedure for hypoplastic left heart syndrome (HLHS). Traditionally the pulmonary circulation has been supplied via a modified Blalock Taussig (BT) shunt but a recent modification, adopted in some UK centres, substitutes a conduit between right ventricle and pulmonary arteries (RV-PA conduit). It is argued that this will result in a more favourable balance between pulmonary and systemic circulations.


OBJECTIVE
To compare the early postoperative haemodynamic profile between patients undergoing a BT shunt or an RV-PA conduit.


METHODS
Retrospective review in a tertiary referral PICU of 51 children with HLHS undergoing the Norwood procedure with either a BT shunt (Group 1; n = 23) or an RV-PA conduit (Group 2; n = 28). Data items were extracted at 10 set time points in the initial 96 h, postoperatively.


RESULTS
Diastolic BP was significantly lower in Group 1 (p<0.001) with a trend towards a higher systolic BP and no difference in mean BP. No between-group differences were found in markers of pulmonary blood flow (PaO2, PaCO2, PaO2/FiO2 ratio), or in markers of systemic blood flow (blood lactate, oxygen extraction ratio), or in estimated ratio of pulmonary:systemic blood flow (Qp:Qs). Despite lower diastolic blood pressure in Group 1 renal and hepatic function did not differ over five post-operative days between groups.


CONCLUSIONS
With the exception of a higher diastolic blood pressure in the RV-PA conduit group, we found no difference in the early haemodynamic profile between patients undergoing an RV-PA conduit or a BT shunt.
Edwards
Linda
L
Department of Paediatric Intensive Care, Birmingham Children's Hospital NHS Trust, Steelhouse Lane, Birmingham, B4 6NH, United Kingdom.
Morris
Kevin P
KP
Siddiqui
Ameen
A
Harrington
Deborah
D
Barron
David
D
Brawn
William
W
D000714:Anastomosis, Surgical; D015415:Biomarkers / Q000097:blood; D001794:Blood Pressure / Q000502:physiology; D006348:Cardiac Surgical Procedures; D005260:Female; D006339:Heart Rate / Q000502:physiology; D006801:Humans; D018636:Hypoplastic Left Heart Syndrome / Q000503:physiopathology / Q000601:surgery*; D007231:Infant, Newborn; D007773:Lactates / Q000097:blood; D008297:Male; D010100:Oxygen / Q000097:blood; D011182:Postoperative Care / Q000379:methods; D011652:Pulmonary Circulation / Q000502:physiology; D016896:Treatment Outcome; D014665:Vasodilator Agents / Q000627:therapeutic use
D015415:Biomarkers; D007773:Lactates; D014665:Vasodilator Agents; D010100:Oxygen