André Rüffer, MD, Florian Arndt, MD, Sergej Potapov, MS, Thomas S

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Early Stage 2 Palliation Is Crucial in Patients With a Right-Ventricle-to-Pulmonary-Artery Conduit André Rüffer, MD, Florian Arndt, MD, Sergej Potapov, MS, Thomas S. Mir, MD, PhD, Jochen Weil, MD, PhD, Robert A. Cesnjevar, MD, PhD The Annals of Thoracic Surgery Volume 91, Issue 3, Pages 816-822 (March 2011) DOI: 10.1016/j.athoracsur.2010.10.040 Copyright © 2011 The Society of Thoracic Surgeons Terms and Conditions

Figure 1 Distribution of shunt types as a function of time periods. (mBTS = modified Blalock-Taussig shunt; RVPAC = right ventricle–to–pulmonary artery conduit.) The Annals of Thoracic Surgery 2011 91, 816-822DOI: (10.1016/j.athoracsur.2010.10.040) Copyright © 2011 The Society of Thoracic Surgeons Terms and Conditions

Figure 2 Summary of outcomes for all patients during 1-year follow-up. (mBTS = modified Blalock-Taussig shunt; RVPAC = right ventricle–to–pulmonary artery conduit.) The Annals of Thoracic Surgery 2011 91, 816-822DOI: (10.1016/j.athoracsur.2010.10.040) Copyright © 2011 The Society of Thoracic Surgeons Terms and Conditions

Figure 3 Kaplan-Meier survival analysis after birth in patients with right ventricle–to–pulmonary artery conduit (RVPAC) or modified Blalock-Taussig shunt (mBTS). (A) 120-day survival. Survival with RVPAC is significantly better (p < 0.01) than with mBTS. (B) 1-year survival. Difference is not significant. The Annals of Thoracic Surgery 2011 91, 816-822DOI: (10.1016/j.athoracsur.2010.10.040) Copyright © 2011 The Society of Thoracic Surgeons Terms and Conditions

Figure 4 Estimated cumulative hazard during the interstage period for patients with right ventricle–to–pulmonary artery conduit (RVPAC) and modified Blalock-Taussig shunt (mBTS). Graphs represent the relation between age and mortality during the interstage period. Patients with early death after stage 1 palliation were excluded. The Annals of Thoracic Surgery 2011 91, 816-822DOI: (10.1016/j.athoracsur.2010.10.040) Copyright © 2011 The Society of Thoracic Surgeons Terms and Conditions

Figure 5 Kaplan-Meier interstage survival analysis with confidence intervals in patients with right ventricle–to–pulmonary artery conduit. Graphs represent survival from birth until death during the interstage period. Patients with early death after stage 1 palliation were excluded. Survival is expressed as a proportion with 95% confidence intervals. Probability of survival to an age of 124 days was 94% ± 6% in the interstage period (95% confidence interval, 83 to 100). The Annals of Thoracic Surgery 2011 91, 816-822DOI: (10.1016/j.athoracsur.2010.10.040) Copyright © 2011 The Society of Thoracic Surgeons Terms and Conditions

Figure 6 Timeline and circumstances of interstage death. Cardiac diagnoses are underlined. (HLHS = hypoplastic left heart syndrome; ISD = interstage death; mBTS = modified Blalock-Taussig shunt; RVPAC = right ventricle–to–pulmonary artery conduit.) The Annals of Thoracic Surgery 2011 91, 816-822DOI: (10.1016/j.athoracsur.2010.10.040) Copyright © 2011 The Society of Thoracic Surgeons Terms and Conditions

Figure 7 Cardiac catheterization and interventions before stage 2 palliation. Differences were not significant. (mBTS = modified Blalock-Taussig shunt; RVPAC = right ventricle–to–pulmonary artery conduit.) The Annals of Thoracic Surgery 2011 91, 816-822DOI: (10.1016/j.athoracsur.2010.10.040) Copyright © 2011 The Society of Thoracic Surgeons Terms and Conditions

Figure 8 Systolic and diastolic flow in right ventricle–to–pulmonary artery conduit. (A) Modified parasternal long-axis view: systolic (red) flow into right ventricle–to–pulmonary artery conduit. (B) Modified parasternal long-axis view: diastolic (blue) regurgitant flow into dominant right ventricle. (C) Continuous wave Doppler with systolic and diastolic flow in right ventricle–to–pulmonary artery conduit. The Annals of Thoracic Surgery 2011 91, 816-822DOI: (10.1016/j.athoracsur.2010.10.040) Copyright © 2011 The Society of Thoracic Surgeons Terms and Conditions