title: Temporary restriction of right ventricle-pulmonary artery conduit flow using haemostatic clips following Norwood I reconstruction: potential for improved outcomes.
abstract: Improved outcomes of the Norwood procedure in hypoplastic left heart syndrome have been achieved by the manipulation of the pulmonary:systemic flow ratio (Qp:Qs) in the early post-operative period, with focus on improving systemic perfusion. As an extension of this Qp:Qs-limiting strategy, we evolved a novel surgical technique to achieve transient flow restriction in the right ventricle-pulmonary artery (RV-PA) conduit for the first 48 h, using haemostatic clips, in a cohort of patients and compared the early outcomes with a non-clipped cohort. Clips were subsequently removed at 48 h at the time of definitive chest closure. We performed RV-PA shunt flow clipping in 37 patients; 75 historical controls had not received clips. Groups were matched for weight, size of ascending aorta, anatomy and circulatory arrest times. Thirty-day mortality was lower in the clipped cohort (2 of 37; 5.4%) versus the unclipped cohort (10 of 75; 13.3%). The minimum blood lactate levels within the first 24 h post-surgery in the unclipped group were significantly higher (P = 0.049), with a significantly lower Qp:Qs in the first 6 h in the clipped patients. These data suggest that limiting Qp:Qs in the early post-operative period following the Norwood procedure may help in the post-operative management of these difficult patients. These results warrant further study.
authors.affiliation: Department of Paediatric Cardiac Surgery,  Birmingham Children's Hospital, Birmingham,  UK.
authors.forename: Bari
authors.initials: B
authors.lastname: Murtuza
authors.forename: Timothy J
authors.initials: TJ
authors.lastname: Jones
authors.forename: David J
authors.initials: DJ
authors.lastname: Barron
authors.forename: William J
authors.initials: WJ
authors.lastname: Brawn
mesh_terms: D000714:Anastomosis, Surgical / Q000379:methods; D004867:Equipment Design; D005500:Follow-Up Studies; D006352:Heart Ventricles / Q000503:physiopathology / Q000601:surgery*; D006489:Hemostatic Techniques / Q000295:instrumentation*; D006801:Humans; D018636:Hypoplastic Left Heart Syndrome / Q000401:mortality / Q000601:surgery*; D058327:Norwood Procedures / Q000379:methods*; D011651:Pulmonary Artery / Q000503:physiopathology / Q000601:surgery*; D012039:Regional Blood Flow; D012189:Retrospective Studies; D015996:Survival Rate / Q000639:trends; D016896:Treatment Outcome; D006113:United Kingdom / Q000453:epidemiology; D014656:Vascular Surgical Procedures / Q000295:instrumentation*