title: Systemic to Pulmonary Artery Versus Right Ventricular to Pulmonary Artery Shunts for Patients With Pulmonary Atresia, Ventricular Septal Defect, and Hypoplastic Pulmonary Arteries.
abstract: OBJECTIVE
  The systemic-pulmonary shunts (SPS) and the right ventricle to pulmonary artery connection (RV-PA connection) are two palliative procedures for patients with pulmonary atresia, ventricular septal defect, and hypoplastic pulmonary arteries. Our aim is to compare early and midterm outcomes of these two procedures.
  
  
  METHODS
  Clinical data of 132 consecutive patients with PA/VSD who underwent the SPS or the RV-PA connection in Fuwai Hospital from January 2011 to June 2014 were retrospectively analyzed. Patients were divided into two groups according to the procedures. Early outcomes including duration of ventilation, length of intensive care unit (ICU) stay, complication incidence, and improvements in oxygen saturation (SpO2 ) were compared. Midterm outcomes including improvement on Nakata index and complete repair rate were evaluated. Death and complete repair were considered as the end-points.
  
  
  RESULTS
  80 patients underwent SPS, 52 patients underwent RV-PA connection. There were three early deaths and six late deaths in SPS group, while there was no early deaths and only one late death in the RV-PA connection group. For the early outcomes, the SO2 increase after RV-PA connection was significantly higher than that SO2 increase after SPS (20% vs. 15%, p < 0.001). There was no statistical difference in length of ICU stay, duration of ventilatory support, or rate of postoperative complications (all p > 0.05) between the SPS group and RV-PA connection group. The incidence of severe postoperative complications and redo-sternotomy rate of the SPS group was significantly higher than that of the RV-PA connection group (12.5% vs. 1.9% [p = 0.018], 11.3% vs. 1.9%, [p = 0.031]). For the median outcomes, the mean follow-up was 2.3 (0.6-4) years. No statistical difference on Nakata index increase (74.1 ± 23.4 mm(2) /m(2) vs. 84.2 ± 48.7 mm(2) /m(2) , p = 0.350) and the complete repair rate (37.2% vs. 42.5%, p = 0.581) was found between the two groups, but the interphase between the initial procedure and complete repair was shorter in RV-PA connection group than that in the SPS group (11.8 ± 3.5m vs. 16.8 ± 8.5 m, p = 0.038).
  
  
  CONCLUSIONS
  There is a significant improvement in oxygen saturation and a more stable perioperative course for patients with RV-PA connection. There is also a shorter interval from the initial procedure to complete repair and a lower mortality after RV-PA connection.
authors.affiliation: PICU, Pediatric Cardiac Center, Fuwai Hospital for Cardiovascular Disease, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, China.
authors.forename: Xu
authors.initials: X
authors.lastname: Wang
authors.affiliation: PICU, Pediatric Cardiac Center, Fuwai Hospital for Cardiovascular Disease, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, China.
authors.forename: Zhongyuan
authors.initials: Z
authors.lastname: Lu
authors.affiliation: Surgery Department, Pediatric Cardiac Center, Fuwai Hospital for Cardiovascular Disease, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, China.
authors.forename: Shoujun
authors.initials: S
authors.lastname: Li
authors.affiliation: Surgery Department, Pediatric Cardiac Center, Fuwai Hospital for Cardiovascular Disease, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, China.
authors.forename: Jun
authors.initials: J
authors.lastname: Yan
authors.affiliation: Surgery Department, Pediatric Cardiac Center, Fuwai Hospital for Cardiovascular Disease, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, China.
authors.forename: Keming
authors.initials: K
authors.lastname: Yang
authors.affiliation: Surgery Department, Pediatric Cardiac Center, Fuwai Hospital for Cardiovascular Disease, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, China.
authors.forename: Qiang
authors.initials: Q
authors.lastname: Wang
mesh_terms: D000015:Abnormalities, Multiple / Q000601:surgery*; D006348:Cardiac Surgical Procedures / Q000379:methods* / Q000401:mortality; D002648:Child; D002675:Child, Preschool; D005260:Female; D005500:Follow-Up Studies; D006345:Heart Septal Defects, Ventricular / Q000601:surgery*; D006352:Heart Ventricles / Q000601:surgery*; D006801:Humans; D015994:Incidence; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D009026:Mortality; D011183:Postoperative Complications / Q000453:epidemiology; D011651:Pulmonary Artery / Q000002:abnormalities* / Q000601:surgery*; D018633:Pulmonary Atresia / Q000601:surgery*; D012086:Reoperation / Q000706:statistics & numerical data; D012189:Retrospective Studies; D056346:Sternotomy / Q000706:statistics & numerical data; D013997:Time Factors; D016896:Treatment Outcome