title: Survival and clinical course at Fontan after stage one palliation with either a modified Blalock-Taussig shunt or a right ventricle to pulmonary artery conduit.
abstract: OBJECTIVE
  We sought to determine whether the type of shunt used at stage one palliation (S1P) affected the survival and the perioperative course through Fontan completion.
  
  
  BACKGROUND
  Although improved surgical and interstage survival have been demonstrated with the use of the right ventricle to pulmonary artery (RV-PA) conduit compared with a modified Blalock-Taussig shunt (BTS) at S1P, it is unknown whether this effect will be observed in long-term follow-up.
  
  
  METHODS
  All patients who underwent a S1P during 2002 and 2003 (n = 80) at our institution were included for analysis. Patients were followed until death or June 1, 2007. Perioperative variables at Fontan completion were recorded.
  
  
  RESULTS
  For the entire cohort, cumulative survival for those who underwent a RV-PA conduit (n = 34) was 79.4% at 3 years compared with 65.8% in the modified BTS group (n = 46) (log-rank = 0.31). At Fontan (n = 44), when compared with those who had received a modified BTS, those who had a RV-PA conduit placed at S1P had no difference in the median duration of ventilation (21 h [range 10 to 96 h] vs. 26.5 h [range 7 to 204 h], p = 0.09) or hospital stay (9 days [range 5 to 29 days] vs. 10 days [range 6 to 48 days], p = 0.89), although length of stay in the intensive care unit was shorter (2 days [range 0 to 6 days] vs. 4 days [range 1 to 25 days], p = 0.01). Sixty-seven percent of the RV-PA conduit group had at least one PA intervention 3 years after S1P compared with 42.8% in the modified BTS group (log-rank = 0.11).
  
  
  CONCLUSIONS
  Nonstatistically significant trends toward improved cumulative survival and increased PA interventions were demonstrated in patients who had a RV-PA conduit placed at S1P. Longitudinal follow-up of larger groups of randomized patients is required to determine the influence of the RV-PA conduit on long-term outcomes.
authors.affiliation: Department of Cardiology, Children's Hospital, Harvard Medical School, Boston, Massachusetts 02115, USA. mark.scheurer@cardio.chboston.org
authors.forename: Mark A
authors.initials: MA
authors.lastname: Scheurer
authors.forename: Joshua W
authors.initials: JW
authors.lastname: Salvin
authors.forename: Vladimiro L
authors.initials: VL
authors.lastname: Vida
authors.forename: Francis
authors.initials: F
authors.lastname: Fynn-Thompson
authors.forename: Emile A
authors.initials: EA
authors.lastname: Bacha
authors.forename: Frank A
authors.initials: FA
authors.lastname: Pigula
authors.forename: John E
authors.initials: JE
authors.lastname: Mayer
authors.forename: Pedro J
authors.initials: PJ
authors.lastname: del Nido
authors.forename: David L
authors.initials: DL
authors.lastname: Wessel
authors.forename: Peter C
authors.initials: PC
authors.lastname: Laussen
authors.forename: Ravi R
authors.initials: RR
authors.lastname: Thiagarajan
mesh_terms: D019917:Blood Vessel Prosthesis Implantation; D006348:Cardiac Surgical Procedures / Q000379:methods* / Q000401:mortality*; D002675:Child, Preschool; D005260:Female; D018729:Fontan Procedure / Q000379:methods* / Q000401:mortality*; D006352:Heart Ventricles / Q000601:surgery; D006439:Hemodynamics; D006801:Humans; D018636:Hypoplastic Left Heart Syndrome / Q000503:physiopathology / Q000601:surgery*; D007223:Infant; D007362:Intensive Care Units; D053208:Kaplan-Meier Estimate; D007902:Length of Stay; D008297:Male; D011651:Pulmonary Artery / Q000601:surgery*; D012189:Retrospective Studies; D014656:Vascular Surgical Procedures / Q000379:methods* / Q000401:mortality*