Establishment of right ventricle-pulmonary artery continuity as the first-stage palliation in older infants with pulmonary atresia with ventricular septal defect may be preferable to use of an arterial shunt.

Right ventricle-pulmonary artery (RV-PA) conduit and systemic-to-pulmonary artery (S-PA) shunt in younger infants for the first-stage palliation with pulmonary atresia with ventricular septal defect (PAVSD) obtained good results. However, the pulmonary arteries (PA) grow slow in older infants undergoing an S-PA shunt. We compared the clinical outcomes of the two procedures in older infants with PAVSD. A total of 48 patients with PAVSD underwent the first-stage palliative procedure between January 2010 and July 2012. Patients were divided into the RV-PA group and the S-PA group based on whether they had an RV-PA conduit (n = 24) or an S-PA shunt (n = 24). The early and late outcomes were compared between groups. There was no significant difference in in-hospital mortality, mechanical ventilation time, paediatric intensive care unit stay and hospital stay between groups (all P > 0.05). The RV-PA conduits were associated with better PA growth compared with the S-PA shunts (P < 0.001). The RV-PA group had a higher rate of second-stage biventricular surgery compared with the S-PA group (P = 0.03). The early outcomes among different conduits of the RV-PA conduit were not different (all P > 0.05). A positive correlation was found between the size of conduits and body weight (R(2) = 0.684, P < 0.001). In older infants with PAVSD who underwent the first-stage palliative procedure, early outcomes showed no difference between the RV-PA conduit group and the S-PA shunt group. The RV-PA conduits were associated with better growth of the PA and higher rates of second-stage biventricular repair. Autologous pericardium is a good choice for RV-PA conduits, and there is a correlation between body weight and size of conduit.

Zheng S ，Yang K ，Li K ，Li S ... -  《-》

Systemic to Pulmonary Artery Versus Right Ventricular to Pulmonary Artery Shunts for Patients With Pulmonary Atresia, Ventricular Septal Defect, and Hypoplastic Pulmonary Arteries.

The systemic-pulmonary shunts (SPS) and the right ventricle to pulmonary artery connection (RV-PA connection) are two palliative procedures for patients with pulmonary atresia, ventricular septal defect, and hypoplastic pulmonary arteries. Our aim is to compare early and midterm outcomes of these two procedures. Clinical data of 132 consecutive patients with PA/VSD who underwent the SPS or the RV-PA connection in Fuwai Hospital from January 2011 to June 2014 were retrospectively analyzed. Patients were divided into two groups according to the procedures. Early outcomes including duration of ventilation, length of intensive care unit (ICU) stay, complication incidence, and improvements in oxygen saturation (SpO2 ) were compared. Midterm outcomes including improvement on Nakata index and complete repair rate were evaluated. Death and complete repair were considered as the end-points. 80 patients underwent SPS, 52 patients underwent RV-PA connection. There were three early deaths and six late deaths in SPS group, while there was no early deaths and only one late death in the RV-PA connection group. For the early outcomes, the SO2 increase after RV-PA connection was significantly higher than that SO2 increase after SPS (20% vs. 15%, p < 0.001). There was no statistical difference in length of ICU stay, duration of ventilatory support, or rate of postoperative complications (all p > 0.05) between the SPS group and RV-PA connection group. The incidence of severe postoperative complications and redo-sternotomy rate of the SPS group was significantly higher than that of the RV-PA connection group (12.5% vs. 1.9% [p = 0.018], 11.3% vs. 1.9%, [p = 0.031]). For the median outcomes, the mean follow-up was 2.3 (0.6-4) years. No statistical difference on Nakata index increase (74.1 ± 23.4 mm(2) /m(2) vs. 84.2 ± 48.7 mm(2) /m(2) , p = 0.350) and the complete repair rate (37.2% vs. 42.5%, p = 0.581) was found between the two groups, but the interphase between the initial procedure and complete repair was shorter in RV-PA connection group than that in the SPS group (11.8 ± 3.5m vs. 16.8 ± 8.5 m, p = 0.038). There is a significant improvement in oxygen saturation and a more stable perioperative course for patients with RV-PA connection. There is also a shorter interval from the initial procedure to complete repair and a lower mortality after RV-PA connection.

Wang X ，Lu Z ，Li S ，Yan J ，Yang K ，Wang Q ... -  《-》

Surgery for right ventricle to pulmonary artery conduit obstruction: risk factors for further reoperation.

Mohammadi S ，Belli E ，Martinovic I ，Houyel L ，Capderou A ，Petit J ，Planché C ，Serraf A ... -  《EUROPEAN JOURNAL OF CARDIO-THORACIC SURGERY》

Development of pulmonary arteries after a central end-to-side shunt in patients with pulmonary atresia, ventricular septal defect, and diminutive pulmonary arteries.

To evaluate the development of pulmonary arteries (PAs) in patients with pulmonary atresia, ventricular septal defect, and diminutive PAs by using a central end-to-side shunt. A total of 103 consecutive patients (71 male and 32 female) with pulmonary atresia, ventricular septal defect, and diminutive PAs received a central end-to-side shunt between PA and aorta from May 2004 to December 2010. The age and weight ranged between 2 to 86 months and 2.5 to 21.5 kg, respectively. Overall 79 patients with main PA diameters less than 4 mm received a central end-to-side shunt between PA and aorta, and 24 patients with main PAs absence received a modified central shunt between PA branches and aorta. There were no deaths during operation and follow-up. Compared with preoperative measures, total PA index increased from mean value 68.8 ± 11.4 mm2/m2 to 129.1 ± 24.9 mm2/m2 (p < 0.001). The increased PA index change at the time of 6 months or final repair after shunt completion was 87.7 ± 27.4% (27-150%). By multivariate regression analysis, age at shunt, shunt procedure, and number of major aortopulmonary collateral arteries were correlated with increasing PA index change. The central end-to-side shunt promoted sufficient growth of the diminutive central PAs, especially in infant patients. Due to the risk of a distortion of pulmonary branches, the authors interposed a modified procedure for patients with main PAs absence by anastomosis of left PA and right PA directly in an end-to-side fashion to the both lateral wall of ascending aorta. It is technically easy to perform, warrants low risk of shunt thrombosis, and flow restriction in the early postoperative period.

Fang M ，Wang H ，Jin Y ，Wang Z ，Wang Z ，Zhang C ... -  《-》

[Postoperative course after first-stage palliation of hypoplastic left heart syndrome with right ventricle-to-pulmonary artery shunt; compared with classic Norwood procedure].

Iwasaki T ，Takeuchi M ，Taga N ，Oe K ，Shimizu K ，Morita K ... -  《-》