Early stage 2 palliation is crucial in patients with a right-ventricle-to-pulmonary-artery conduit
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Early stage 2 palliation is crucial in patients with a right-ventricle-to-pulmonary-artery conduit. / Rüffer, André; Arndt, Florian; Potapov, Sergej; Mir, Thomas S; Weil, Jochen; Cesnjevar, Robert A.
In: ANN THORAC SURG, Vol. 91, No. 3, 03.2011, p. 816-822.Research output: SCORING: Contribution to journal › SCORING: Journal article › Research › peer-review
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T1 - Early stage 2 palliation is crucial in patients with a right-ventricle-to-pulmonary-artery conduit
AU - Rüffer, André
AU - Arndt, Florian
AU - Potapov, Sergej
AU - Mir, Thomas S
AU - Weil, Jochen
AU - Cesnjevar, Robert A
N1 - Copyright © 2011 The Society of Thoracic Surgeons. Published by Elsevier Inc. All rights reserved.
PY - 2011/3
Y1 - 2011/3
N2 - BACKGROUND: Improved survival after Norwood stage 1 palliation is giving more patients the opportunity to reach stage 2 palliation; thus, more patients are exposed to the risk of interstage death.METHODS: A single-center review of patients who underwent stage 1 palliation from January 1998 to December 2007 (n = 58) was performed. Pulmonary blood flow was established either by a modified Blalock-Taussig-shunt (mBTS, n = 33) or a right ventricle-to-pulmonary artery conduit (RVPAC, n = 25).RESULTS: Hospital, interstage, and 1-year survival was not significantly different between groups. However, Kaplan-Meier survival analysis reflected a significantly higher survival probability for RVPAC patients until the age of 120 days (RVAPC, 92% ± 5% [standard error of the mean]; 95% confidence interval, 82 to 100; mBTS, 63% ± 9%; 95% confidence interval, 48 to 82; p = 0.01). During a 1-year follow-up, all 11 nonsurvivors with mBTS died at an age younger than 120 days, including 2 patients with early stage 2 palliation. In contrast, besides 2 early deaths, all RVPAC patients (n = 5) showed later attrition at an age older than 120 days while awaiting stage 2 palliation. Interstage death occurred significantly later among RVPAC patients (RVPAC, 146 ± 60 days versus mBTS, 81 ± 23 days; p = 0.01). After stage 2 palliation, all patients with RVPAC survived, including 7 patients with surgery at an age younger than 120 days. All interstage and late deaths were related to compromising cardiac lesions with no statistical difference between groups.CONCLUSIONS: After Norwood stage 1 palliation, survival was improved with RVPAC for the first 4 months. However, a loss of the favorable primary outcome was present by delaying stage 2 palliation beyond the age of 120 days. Progressive volume load as a result of conduit regurgitation may play a crucial role for later attrition. Residual lesions should be addressed early to preserve cardiac function.
AB - BACKGROUND: Improved survival after Norwood stage 1 palliation is giving more patients the opportunity to reach stage 2 palliation; thus, more patients are exposed to the risk of interstage death.METHODS: A single-center review of patients who underwent stage 1 palliation from January 1998 to December 2007 (n = 58) was performed. Pulmonary blood flow was established either by a modified Blalock-Taussig-shunt (mBTS, n = 33) or a right ventricle-to-pulmonary artery conduit (RVPAC, n = 25).RESULTS: Hospital, interstage, and 1-year survival was not significantly different between groups. However, Kaplan-Meier survival analysis reflected a significantly higher survival probability for RVPAC patients until the age of 120 days (RVAPC, 92% ± 5% [standard error of the mean]; 95% confidence interval, 82 to 100; mBTS, 63% ± 9%; 95% confidence interval, 48 to 82; p = 0.01). During a 1-year follow-up, all 11 nonsurvivors with mBTS died at an age younger than 120 days, including 2 patients with early stage 2 palliation. In contrast, besides 2 early deaths, all RVPAC patients (n = 5) showed later attrition at an age older than 120 days while awaiting stage 2 palliation. Interstage death occurred significantly later among RVPAC patients (RVPAC, 146 ± 60 days versus mBTS, 81 ± 23 days; p = 0.01). After stage 2 palliation, all patients with RVPAC survived, including 7 patients with surgery at an age younger than 120 days. All interstage and late deaths were related to compromising cardiac lesions with no statistical difference between groups.CONCLUSIONS: After Norwood stage 1 palliation, survival was improved with RVPAC for the first 4 months. However, a loss of the favorable primary outcome was present by delaying stage 2 palliation beyond the age of 120 days. Progressive volume load as a result of conduit regurgitation may play a crucial role for later attrition. Residual lesions should be addressed early to preserve cardiac function.
KW - Blood Flow Velocity
KW - Cardiac Catheterization
KW - Female
KW - Follow-Up Studies
KW - Germany/epidemiology
KW - Heart Ventricles/physiopathology
KW - Humans
KW - Hypoplastic Left Heart Syndrome/mortality
KW - Infant
KW - Male
KW - Norwood Procedures/methods
KW - Palliative Care/methods
KW - Prognosis
KW - Pulmonary Artery/physiopathology
KW - Retrospective Studies
KW - Survival Rate/trends
KW - Time Factors
U2 - 10.1016/j.athoracsur.2010.10.040
DO - 10.1016/j.athoracsur.2010.10.040
M3 - SCORING: Journal article
C2 - 21353005
VL - 91
SP - 816
EP - 822
JO - ANN THORAC SURG
JF - ANN THORAC SURG
SN - 0003-4975
IS - 3
ER -
