title: A reinforced right-ventricle-to-pulmonary-artery conduit for the stage-1 Norwood procedure improves pulmonary artery growth.
abstract: OBJECTIVE
  To compare early postoperative outcomes, angiographic, and intervention findings and 1-year survival between 2 groups of infant patients: those receiving a standard right-ventricle-to-pulmonary-artery (RV-PA) conduit versus a ring-reinforced RV-PA conduit, in undergoing Norwood stage-1 surgery for hypoplastic left heart syndrome (HLHS). The technique of using such a ring-reinforced graft, placed through a limited ventriculotomy, has theoretic advantages in preserving right ventricular function, compared with the standard technique of RV-PA conduit creation.
  
  
  METHODS
  This retrospective cohort study was performed between July 2006 and July 2013. A total of 87 patients with HLHS underwent Norwood stage-1 surgery during this period; 48 received a standard nonreinforced RV-PA conduit; 39 received a ring-reinforced conduit. Primary and secondary outcomes were survival and need for cardiac reintervention up to age 12 months.
  
  
  RESULTS
  No difference was found in transplant-free survival by age 12 months (87% ring-reinforced vs 73% nonreinforced, P = .12). The group with the nonreinforced, versus ring-reinforced, grafts had more interventions in the first year (69% vs 35%, respectively; P < .01). Before stage 2, the pulmonary artery pulse pressure was greater in the group with ring-reinforced grafts (9.1 ± 4.1 vs 4.8 ± 3.1 mm Hg, P < .001), with no difference in mean pressure (15.2 ± 3.32 vs 14.3 ± 3.48 mm Hg, P = .27). The corrected pulmonary artery index (Nakata) was greater in the group with ring-reinforced grafts (213 ± 76 vs 134 ± 68 mm(2)/m(2), P < .0001).
  
  
  CONCLUSIONS
  A ring-reinforced conduit is associated with reduced intervention, as well as higher pulse pressures and improved pulmonary artery growth, in infants undergoing stage-1 palliation for HLHS.
authors: Department of Cardiology, Boston Children's Hospital, and Department of Pediatrics, Harvard Medical School, Boston, Mass.
authors: James R
authors: JR
authors: Bentham
authors: Department of Cardiac Surgery, Boston Children's Hospital, and Department of Surgery, Harvard Medical School, Boston, Mass.
authors: Christopher W
authors: CW
authors: Baird
authors: Department of Cardiology, Boston Children's Hospital, and Department of Pediatrics, Harvard Medical School, Boston, Mass.
authors: Deigo P
authors: DP
authors: Porras
authors: Department of Cardiology, Boston Children's Hospital, and Department of Pediatrics, Harvard Medical School, Boston, Mass.
authors: Rahul H
authors: RH
authors: Rathod
authors: Department of Cardiology, Boston Children's Hospital, and Department of Pediatrics, Harvard Medical School, Boston, Mass. Electronic address: audrey.marshall@cardio.chboston.org.
authors: Audrey C
authors: AC
authors: Marshall
mesh_terms: D062186:Arterial Pressure; D001807:Blood Vessel Prosthesis; D019917:Blood Vessel Prosthesis Implantation / Q000009:adverse effects / Q000295:instrumentation* / Q000379:methods / Q000401:mortality; D001900:Boston; D002648:Child; D002675:Child, Preschool; D005260:Female; D006352:Heart Ventricles / Q000002:abnormalities / Q000503:physiopathology / Q000601:surgery*; D006801:Humans; D018636:Hypoplastic Left Heart Syndrome / Q000175:diagnosis / Q000401:mortality / Q000503:physiopathology / Q000601:surgery*; D007223:Infant; D008297:Male; D058327:Norwood Procedures / Q000009:adverse effects / Q000295:instrumentation* / Q000379:methods / Q000401:mortality; D011183:Postoperative Complications / Q000401:mortality / Q000601:surgery; D011474:Prosthesis Design; D011651:Pulmonary Artery / Q000000981:diagnostic imaging / Q000254:growth & development / Q000601:surgery*; D011859:Radiography; D012086:Reoperation; D012189:Retrospective Studies; D013997:Time Factors; D016896:Treatment Outcome
keywords: Congenital heart disease; Norwood surgery; hypoplastic left heart syndrome; right ventricle to pulmonary artery conduit