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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 (March 2011) DOI: /j.athoracsur Copyright © 2011 The Society of Thoracic Surgeons Terms and Conditions
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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 , DOI: ( /j.athoracsur ) Copyright © 2011 The Society of Thoracic Surgeons Terms and Conditions
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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 , DOI: ( /j.athoracsur ) Copyright © 2011 The Society of Thoracic Surgeons Terms and Conditions
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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 , DOI: ( /j.athoracsur ) Copyright © 2011 The Society of Thoracic Surgeons Terms and Conditions
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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 , DOI: ( /j.athoracsur ) Copyright © 2011 The Society of Thoracic Surgeons Terms and Conditions
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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 , DOI: ( /j.athoracsur ) Copyright © 2011 The Society of Thoracic Surgeons Terms and Conditions
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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 , DOI: ( /j.athoracsur ) Copyright © 2011 The Society of Thoracic Surgeons Terms and Conditions
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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 , DOI: ( /j.athoracsur ) Copyright © 2011 The Society of Thoracic Surgeons Terms and Conditions
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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 , DOI: ( /j.athoracsur ) Copyright © 2011 The Society of Thoracic Surgeons Terms and Conditions
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