Early stage 2 palliation is crucial in patients with a right-ventricle-to- pulmonary-artery conduit
Rüffer A, Arndt F, Potapov S, Mir TS, Weil J, Cesnjevar R (2011)
Publication Type: Journal article
Publication year: 2011
Journal
Book Volume: 91
Pages Range: 816-822
Journal Issue: 3
DOI: 10.1016/j.athoracsur.2010.10.040
Abstract
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 ventricletopulmonary 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. © 2011 The Society of Thoracic Surgeons.
Authors with CRIS profile
Sergej Potapov
Medizinische Fakultät
Robert Cesnjevar
Lehrstuhl für Herzchirurgie mit dem Schwerpunkt Kinderherzchirurgie
Involved external institutions
Germany (DE)How to cite
APA:
Rüffer, A., Arndt, F., Potapov, S., Mir, T.S., Weil, J., & Cesnjevar, R. (2011). Early stage 2 palliation is crucial in patients with a right-ventricle-to- pulmonary-artery conduit. Annals of Thoracic Surgery, 91(3), 816-822. https://doi.org/10.1016/j.athoracsur.2010.10.040
MLA:
Rüffer, André, et al. "Early stage 2 palliation is crucial in patients with a right-ventricle-to- pulmonary-artery conduit." Annals of Thoracic Surgery 91.3 (2011): 816-822.
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