title: Impact of pre-stage II hemodynamics and pulmonary artery anatomy on 12-month outcomes in the Pediatric Heart Network Single Ventricle Reconstruction trial.
abstract: OBJECTIVE
  To compare the interstage cardiac catheterization hemodynamic and angiographic findings between shunt types for the Pediatric Heart Network Single Ventricle Reconstruction trial. The trial, which randomized subjects to a modified Blalock-Taussig shunt (MBTS) or right ventricle-to-pulmonary artery shunt (RVPAS) for the Norwood procedure, demonstrated the RVPAS was associated with a smaller pulmonary artery diameter but superior 12-month transplant-free survival.
  
  
  METHODS
  We analyzed the pre-stage II catheterization data for the trial subjects. The hemodynamic variables and shunt and pulmonary angiographic data were compared between shunt types; their association with 12-month transplant-free survival was also evaluated.
  
  
  RESULTS
  Of 549 randomized subjects, 389 underwent pre-stage II catheterization. A smaller size, lower aortic and superior vena cava saturation, and higher ventricular end-diastolic pressure were associated with worse 12-month transplant-free survival. The MBTS group had a lower coronary perfusion pressure (27 vs 32 mm Hg; P<.001) and greater pulmonary blood flow/systemic blood flow ratio (1.1 vs 1.0, P=.009). A greater pulmonary blood flow/systemic blood flow ratio increased the risk of death or transplantation only in the RVPAS group (P=.01). The MBTS group had fewer shunt (14% vs 28%, P=.004) and severe left pulmonary artery (0.7% vs 9.2%, P=.003) stenoses, larger mid-main branch pulmonary artery diameters, and greater Nakata indexes (164 vs 134, P<.001).
  
  
  CONCLUSIONS
  Compared with the RVPAS subjects, the MBTS subjects had more hemodynamic abnormalities related to shunt physiology, and the RVPAS subjects had more shunt or pulmonary obstruction of a severe degree and inferior pulmonary artery growth at pre-stage II catheterization. A lower body surface area, greater ventricular end-diastolic pressure, and lower superior vena cava saturation were associated with worse 12-month transplant-free survival.
authors: Division of Pediatric Cardiology, University of Michigan Medical School, Ann Arbor, Mich. Electronic address: ranjita@umich.edu.
authors: Ranjit
authors: R
authors: Aiyagari
authors: Duke University Medical Center, Durham, NC.
authors: John F
authors: JF
authors: Rhodes
authors: New England Research Institute, Watertown, Mass.
authors: Peter
authors: P
authors: Shrader
authors: Nemours Cardiac Center, Wilmington, Del.
authors: Wolfgang A
authors: WA
authors: Radtke
authors: Department of Pediatrics, Medical University of South Carolina, Charleston, SC.
authors: Varsha M
authors: VM
authors: Bandisode
authors: Department of Cardiology, Children's Hospital Boston, Boston, Mass.
authors: Lisa
authors: L
authors: Bergersen
authors: Division of Pediatric Cardiology, Children's Hospital of Philadelphia, Philadelphia, Pa.
authors: Matthew J
authors: MJ
authors: Gillespie
authors: Division of Pediatric Cardiology, University of Utah, Salt Lake City, Utah.
authors: Robert G
authors: RG
authors: Gray
authors: New England Research Institute, Watertown, Mass.
authors: Lin T
authors: LT
authors: Guey
authors: Duke University Medical Center, Durham, NC.
authors: Kevin D
authors: KD
authors: Hill
authors: Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio.
authors: Russel
authors: R
authors: Hirsch
authors: Children's Healthcare of Atlanta, Emory University, Atlanta, Ga.
authors: Dennis W
authors: DW
authors: Kim
authors: The Hospital for Sick Children, Toronto, Ontario, Canada.
authors: Kyong-Jin
authors: KJ
authors: Lee
authors: Department of Pediatrics, Medical College of Wisconsin, Milwaukee, Wis.
authors: Andrew N
authors: AN
authors: Pelech
authors: Division of Cardiology, All Children's Hospital, St Petersburg, Fla.
authors: Jeremy
authors: J
authors: Ringewald
authors: Division of Pediatric Cardiology, Children's Hospital Los Angeles, Los Angeles, Calif.
authors: Cheryl
authors: C
authors: Takao
authors: Division of Cardiology, New York-Presbyterian Morgan Stanley Children's Hospital, New York, NY.
authors: Julie A
authors: JA
authors: Vincent
authors: Section of Pediatric Cardiovascular Surgery, University of Michigan Medical School, Ann Arbor, Mich.
authors: Richard G
authors: RG
authors: Ohye
mesh_terms: D058366:Blalock-Taussig Procedure; D002675:Child, Preschool; D017023:Coronary Angiography; D005260:Female; D006330:Heart Defects, Congenital / Q000000981:diagnostic imaging / Q000601:surgery*; D006352:Heart Ventricles / Q000002:abnormalities* / Q000000981:diagnostic imaging / Q000601:surgery*; D006439:Hemodynamics; D006801:Humans; D008297:Male; D009656:North America; D058327:Norwood Procedures; D011651:Pulmonary Artery / Q000002:abnormalities*; D016896:Treatment Outcome