title: Selective Use of the Blalock-Taussig Shunt and Right Ventricle-to-Pulmonary Artery Conduit During the Norwood Procedure.
abstract: BACKGROUND
  The single ventricle reconstruction trial showed better one-year transplant-free survival for the right ventricle-to-pulmonary artery (RV-to-PA) conduit over the modified Blalock-Taussig shunt (mBTS) at Norwood operation. However, concerns remain about the long-term effects of a neonatal ventriculotomy. In our institution, we have used specific selection criteria for the use of mBTS in the Norwood operation.
  
  
  METHODS
  We reviewed 122 consecutive neonates undergoing the Norwood procedure from December 2006 to December 2013. We used the following criteria to select our source of pulmonary blood flow: (1) presence of a dominant morphologic left ventricle; (2) presence of antegrade blood in an ascending aorta that is greater than 3 mm; and (3) presence of significant large "crossing coronaries" on ventricle. All patients who met any of the above 3 criteria underwent an mBTS while the remaining patients underwent an RV-to-PA conduit.
  
  
  RESULTS
  Seventy-five (61.5%) patients had the RV-to-PA conduit and 47 (38.5%) patients had an mBTS. The overall surgical mortality was 9%. Mean follow-up interval was 23.5 months. Actuarial transplant-free survival was similar at 12, 24, 36, and 48 months in both the mBTS group and the RV-to-PA conduit group. In the RV-to-PA conduit group, actuarial transplant-free survival was 73% at 12 months, 71% at 24 months, 71% at 36 months, and 67% at 48 months, while in the mBTS group, actuarial transplant-free survival was 82% at 12 months, 75% at 24 months, 75% at 36 months, and 75% at 48 months.
  
  
  CONCLUSIONS
  Our selection criteria for mBTS have allowed us to obtain equivalent transplant-free survival at 12, 24, 36, and 48 months when compared to the RV-to-PA conduit group.
authors.affiliation: Department of Cardiovascular Surgery, Rady Children's Hospital, San Diego, CA, USA raghavamurthy@yahoo.com.
authors.forename: Raghav
authors.initials: R
authors.lastname: Murthy
authors.affiliation: Division of Pediatric Cardiothoracic Surgery, Cook Children's Hospital, Fort Worth, TX, USA.
authors.forename: Vinod A
authors.initials: VA
authors.lastname: Sebastian
authors.affiliation: Research Department, Children's Medical Center Dallas, TX, USA.
authors.forename: Rong
authors.initials: R
authors.lastname: Huang
authors.affiliation: Department of Cardiovascular and Thoracic Surgery, Children's Medical Center, Dallas, TX, USA.
authors.forename: Kristine J
authors.initials: KJ
authors.lastname: Guleserian
authors.affiliation: Department of Cardiovascular and Thoracic Surgery, Children's Medical Center, Dallas, TX, USA.
authors.forename: Joseph M
authors.initials: JM
authors.lastname: Forbess
mesh_terms: D001011:Aorta / Q000601:surgery; D058366:Blalock-Taussig Procedure; D018572:Disease-Free Survival; D005260:Female; D016027:Heart Transplantation; D006352:Heart Ventricles / Q000601:surgery; D006801:Humans; D018636:Hypoplastic Left Heart Syndrome / Q000401:mortality / Q000601:surgery*; D007231:Infant, Newborn; D053208:Kaplan-Meier Estimate; D008297:Male; D058327:Norwood Procedures; D011651:Pulmonary Artery / Q000601:surgery; D012189:Retrospective Studies; D016896:Treatment Outcome
keywords: CHD; Norwood procedure; hypoplastic left heart syndrome; outcomes; univentricular heart