10. The modified blalock € taussig shunt versus right ventricle to pulmonary artery shunt for stage one norwood procedure: An 11 year experience

Abstract

Clinical Research. Oral Presentation. The success of the surgical treatment for Hypoplastic Left Heart Syndrome (HLHS) outside North America and Europe has not been well demonstrated. Furthermore, the optimal type of shunt associated with the Norwood operation is not yet determined. In this retrospective study we report the outcomes of the Norwood operation from a single institution and compare outcomes for patients receiving either a modified Blalock Taussig shunt (BT) or a non-valved right ventricle to pulmonary artery (Sano) shunt. Between January 2004 and December 2014, 117 patients underwent the Norwood procedure at King Faisal Specialist Hospital in Jeddah, Saudi Arabia. BT shunt was done in 88 patients and Sano shunt was done in 29 patients. Their electronic and paper charts were reviewed and the outcomes reported. The mean age at surgery was 28 ± 17.13 days in the BT group and 33.79 ± 18.67 days in the Sano group (p = 0.208). Body weight was not significantly different between the two groups 3.23 ± 0.65 and 2.98 ± 0.48, respectively. ICU stay and total hospital stay were also comparable 19.75 ± 11.14 days versus 14.21 ± 10.59 days and 34.77 ± 26.89 days versus 26.86 ± 20.17 days, respectively. Most of our patients were left with open chest 66 (75.0%) in the BT group and 24 (82.8%) in the Sano group, (p = 0.278) for several days. ECMO was used for 17 patients (19.3%) in BT group and 5 patients in the (17.2%) in Sano group (p = 0.522). In–hospital mortality was 11 (12.5%) in the BT group and 5 (17.2%) in the Sano group, (p = 0.357). None of the patients received heart transplantation due to its unavailability. The Norwood operation can be successful with good results that warrant offering treatment to most newborns with HLHS in our setting. Lack of heart transplantation and perceived poor outcomes should not be considered sufficient reasons to deny surgical care to HLHS patients. In this study, there is no demonstrable difference in early outcomes between the BT shunt and the Sano shunt.