The Norwood With Blalock-Taussig-Thomas Shunt; Unfairly Maligned?
Edo K. S. Bedzra, MD, MBA1, Jennifer Marshall, MPH, RN1, Manasa Gadiraju2, Alex Schray2, James E. O'Brien, Jr., MD1.
1Children's Mercy Hospital, Kansas City, MO, USA, 2University of Missouri Kansas City School of Medicine, Kansas City, MO, USA.
Objective(s): We set out to test the hypothesis that the findings of the SVR trial would hold in a contemporary cohort.
Methods: We conducted a retrospective analysis of all patients who underwent the Norwood procedure from 2014-2022 at a single center. Results: 93 patients underwent the Norwood procedure at a median age of 7.3 days (IQR 4.4,9.4), and 39 weeks gestation (IQR 38,39). 67.7% had hypoplastic left heart syndrome, and 9.7% each had Unbalanced Atrioventricular Septal Defect, and Double Inlet Left ventricle. 40 patients received a Blalock-Taussig-Thomas Shunt, BTTS, compared to 53 Sano shunts (RVPA). 25% of BTTS and 22.6% of RVPA required postoperative ECMO (p = 0.84). There was no difference in operative mortality , (BTTS 12.5%, RVPA 9.4%, p = 0.67), death or transplant at 1 year (BTTS 12.5%, RVPA 7.5%, p = 0.47), between 1 and 3 years (BTTS 2.5%, RVPA 3.8%, p = 0.74) or between 3 and 6 years (BTTS 7.5%, RVPA 0%, p = 0.05). Kaplan Meier transplant free survival at 1 (BTTS 87.5%, RVPA 92.5%), and 5 years (BTTS 80.9%, RVPA 88.7%) was similar (log rank p = 0.60). Median hospital length of stay showed no difference between the groups (BTTS 53.9 (IQR 32,94), RVPA 52.0 (IQR 36,83), p = 0.9).
Conclusions: In the current era, patients undergoing the Norwood Procedure with BTTS have similar short and long term survival to those with RVPA. The BTTS may be safe and non-inferior for the Norwood palliation.
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