Impact of pre-stage II hemodynamics and pulmonary artery anatomy on 12-month outcomes in the Pediatric Heart Network Single Ventricle Reconstruction trial

The Journal of Thoracic and Cardiovascular Surgery
Ranjit AiyagariPediatric Heart Network Investigators

Abstract

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. 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. 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 ...Continue Reading

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Citations

Oct 31, 2015·The Journal of Thoracic and Cardiovascular Surgery·Robert D B Jaquiss
Apr 15, 2015·The Journal of Thoracic and Cardiovascular Surgery·James R BenthamAudrey C Marshall
Nov 27, 2014·Frontiers in Pediatrics·Raoul Roman ArnoldMatthias Gorenflo
Jul 17, 2016·European Journal of Cardio-thoracic Surgery : Official Journal of the European Association for Cardio-thoracic Surgery·James WongGerald F Greil
Mar 10, 2017·The Journal of Thoracic and Cardiovascular Surgery·Nicholas D AndersenRobert D B Jaquiss
Nov 13, 2014·Current Opinion in Cardiology·Daniel J DiBardino
Jul 11, 2020·Seminars in Cardiothoracic and Vascular Anesthesia·Ray S ChoiMorgan L Brown
Aug 12, 2020·Pediatric Cardiology·Marie VincentiFrank Cetta
Jun 28, 2018·Pediatric Cardiology·Thomas J KulikStephen P Sanders

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