title: Establishment of right ventricle-pulmonary artery continuity as the first-stage palliation in older infants with pulmonary atresia with ventricular septal defect may be preferable to use of an arterial shunt.
abstract: OBJECTIVE
  Right ventricle-pulmonary artery (RV-PA) conduit and systemic-to-pulmonary artery (S-PA) shunt in younger infants for the first-stage palliation with pulmonary atresia with ventricular septal defect (PAVSD) obtained good results. However, the pulmonary arteries (PA) grow slow in older infants undergoing an S-PA shunt. We compared the clinical outcomes of the two procedures in older infants with PAVSD.
  
  
  METHODS
  A total of 48 patients with PAVSD underwent the first-stage palliative procedure between January 2010 and July 2012. Patients were divided into the RV-PA group and the S-PA group based on whether they had an RV-PA conduit (n = 24) or an S-PA shunt (n = 24). The early and late outcomes were compared between groups.
  
  
  RESULTS
  There was no significant difference in in-hospital mortality, mechanical ventilation time, paediatric intensive care unit stay and hospital stay between groups (all P > 0.05). The RV-PA conduits were associated with better PA growth compared with the S-PA shunts (P < 0.001). The RV-PA group had a higher rate of second-stage biventricular surgery compared with the S-PA group (P = 0.03). The early outcomes among different conduits of the RV-PA conduit were not different (all P > 0.05). A positive correlation was found between the size of conduits and body weight (R(2) = 0.684, P < 0.001).
  
  
  CONCLUSIONS
  In older infants with PAVSD who underwent the first-stage palliative procedure, early outcomes showed no difference between the RV-PA conduit group and the S-PA shunt group. The RV-PA conduits were associated with better growth of the PA and higher rates of second-stage biventricular repair. Autologous pericardium is a good choice for RV-PA conduits, and there is a correlation between body weight and size of conduit.
authors.affiliation: Department of Surgery, National Center for Cardiovascular Disease, China and Fuwai Hospital, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, China Department of Cardiac Surgery, Anzhen Hospital, Capital Medical University, Beijing, China.
authors.forename: Shuai
authors.initials: S
authors.lastname: Zheng
authors.affiliation: Department of Surgery, National Center for Cardiovascular Disease, China and Fuwai Hospital, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, China ykmzmc3227@hotmail.com.
authors.forename: Keming
authors.initials: K
authors.lastname: Yang
authors.affiliation: Department of Surgery, National Center for Cardiovascular Disease, China and Fuwai Hospital, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, China.
authors.forename: Kun
authors.initials: K
authors.lastname: Li
authors.affiliation: Department of Surgery, National Center for Cardiovascular Disease, China and Fuwai Hospital, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, China.
authors.forename: Shoujun
authors.initials: S
authors.lastname: Li
mesh_terms: D000367:Age Factors; D001835:Body Weight; D006348:Cardiac Surgical Procedures / Q000009:adverse effects / Q000379:methods* / Q000401:mortality; D002648:Child; D002675:Child, Preschool; D005260:Female; D006343:Heart Septal Defects / Q000175:diagnosis / Q000401:mortality / Q000503:physiopathology / Q000601:surgery*; D006352:Heart Ventricles / Q000503:physiopathology / Q000601:surgery*; D006439:Hemodynamics; D017052:Hospital Mortality; D006801:Humans; D007223:Infant; D007902:Length of Stay; D008297:Male; D010166:Palliative Care; D010496:Pericardium / Q000637:transplantation*; D011183:Postoperative Complications / Q000401:mortality / Q000628:therapy; D011651:Pulmonary Artery / Q000254:growth & development / Q000503:physiopathology / Q000601:surgery*; D018633:Pulmonary Atresia / Q000175:diagnosis / Q000401:mortality / Q000503:physiopathology / Q000601:surgery*; D011652:Pulmonary Circulation; D012189:Retrospective Studies; D013997:Time Factors; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome; D016278:Ventricular Function, Right
keywords: Congenital heart diseases; Pulmonary arteries; Septal defect; Shunts