Comparison of Early Clinical Outcomes between Systemic-Pulmonary Shunts and Right Ventricular to Pulmonary Artery Connection for Patients with Pulmonary Atresia and Ventricular Septal Defect_Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

LUZhong-yuan ¹ , LIShou-jun ² ,  WANGXu ¹ , YANJun ² , YANGKe-ming ² , WANGQiang ²

1. Pediatric ICU, Pediatric Cardiac Center, Fu Wai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Science and Peking Union Medical College, Beijing 100037, P. R. China;
2. Department of Surgery, Pediatric Cardiac Center, Fu Wai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Science and Peking Union Medical College, Beijing 100037, P. R. China;

Corresponding author：

WANGXu, Email: fwpicu@163.com

Keywords：

Pulmonary atresia; Ventricular septal defect; Systemic-pulmonary shunts; Right ventricular to pulmonary artery connection

DOI：

10.7507/1007-4848.20140133

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Objective To compare early clinical outcomes between systemic-pulmonary shunts (SPS) and right ventricular to pulmonary artery connection (RV-PA connection) for patients with pulmonary atresia and ventricular septal defect (PA/VSD), and investigate early management strategies for these 2 different palliative procedures. Methods We retrospectively analyzed clinical data of 89 PA/VSD patients who underwent SPS or RV-PA connection in Fu Wai Hospital from January 2009 to December 2011. According to different surgical procedures, all the 89 patients were divided into 2 groups. In SPS group, there were 59 patients including 35 males and 24 females with their median age of 25 months (4 months to 8 years). In RV-PA connection group, there were 30 patients including 19 males and 11 females with their median age of 24 months (28 days to 7 years and 2 months). Early clinical outcomes including mechanical ventilation time, length of ICU stay, morbidity, reexploration, improvement of oxygen saturation (SO₂) and mortality were compared between the 2 groups. Results Among 59 patients in SPS group, 3 patients (5.1%) died postoperatively. There was no in-hospital death among 30 patients in RV-PA connection group. The improvement of percentage of SO₂ of RV-PA connection group was significantly higher than that of SPS group (31.7% vs. 22.2%, P < 0.05). There was no statistical difference in length of ICU stay (3.6±2.5 days vs. 4.2±5.1 days, P > 0.05), mechanical ventilation time (34.8±33.5 hours vs. 44.3±39.6 hours, P > 0.05), postoperative morbidity (37.3% vs. 30.0%, P > 0.05) or reexploration rate (15.3% vs. 6.7%, P > 0.05) between SPS group and RV-PA connection group. Incidence of serious postoperative complications of SPS group was signi-ficantly higher than that of RV-PA connection group (25.4% vs. 6.7%, P < 0.05). Conclusion Early clinical outcomes of RV-PA connection is better than SPS for PA/VSD patients including greater SO₂ improvement and lower mortality. Mid-term and long-term clinical results as well as larger study samples are needed for better evaluation.

Citation： LUZhong-yuan, LIShou-jun, WANGXu, YANJun, YANGKe-ming, WANGQiang. Comparison of Early Clinical Outcomes between Systemic-Pulmonary Shunts and Right Ventricular to Pulmonary Artery Connection for Patients with Pulmonary Atresia and Ventricular Septal Defect. Chinese Journal of Clinical Thoracic and Cardiovascular Surgery, 2014, 21(4): 468-472. doi: 10.7507/1007-4848.20140133 Copy

1.	邓喜成, 李守军.肺动脉闭锁合并室间隔缺损的外科治疗策略.中国胸心血管外科临床杂志, 2010, 17 (1):50-54.
2.	Murthy K, Reddy KP, Nagarajan R, et al. Management of ventricular septal defect with pulmonary atresia and major aorto pulmonary colla-teral arteries:Challenges and controversies. Ann Pediatr Cardiol, 2010, 3 (2):127-135.
3.	Brizard CP, Liava'a M, d'Udekem Y. Pulmonary atresia, VSD and Mapcas:repair without unifocalization. Semin Thorac Cardiovasc Surg Pediatr Card Surg Annu, 2009, 12 (1):139-144.
4.	Liava'a M, Brizard CP, Konstantinov IE, et al. Pulmonary atresia, ventricular septal defect, and major aortopulmonary collaterals:neon-atal pulmonary artery rehabilitation without unifocalization. Ann Thorac Surg, 2012, 93 (1):185-191.
5.	Gerelli S, van Steenberghe M, Murtuza B, et al. Neonatal right vent-ricle to pulmonary connection as a palliative procedure for pulmonary atresia with ventricular septal defect or severe tetralogy of Fallot. Eur J Cardiothorac Surg, 2014, 45 (2):278-288.
6.	Mumtaz MA, Rosenthal G, Qureshi A, et al. Melbourne shunt promotes growth of diminutive central pulmonary arteries in patients with pulmonary atresia, ventricular septal defect, and systemic topulmonary collateral arteries. Ann Thorac Surg, 2008, 85 (6):2079-2084.
7.	Ahmad U, Fatimi SH, Naqvi I, et al. Modified Blalock-Taussig shunt:immediate and short-term follow-up results in neonates. Heart Lung Circ, 2008, 17 (1):54-58.
8.	Mohammadi S, Benhameid O, Campbell A, et al. Could we still improve early and interim outcome after prosthetic systemic-pulmonary shunt? A risk factors analysis. Eur J Cardiothorac Surg, 2008, 34 (3):545-549.
9.	Wells WJ, Yu RJ, Batra AS, et al. Obstruction in modified Blalock shunts:a quantitative analysis with clinical correlation. Ann Thorac Surg, 2005, 79 (6):2072-2076.
10.	Gedicke M, Morgan G, Parry A, et al. Risk factors for acute shunt blockage in children after modified Blalock-Taussig shunt operations. Heart Vessels, 2010, 25 (5):405-409.
11.	Ghanayem NS, Jaquiss RD, Cava JR, et al. Right ventricle-to-pulmonary artery conduit versus Blalock-Taussig shunt:a hemodynamic comparison. Ann Thorac Surg, 2006, 82 (5):1603-1610.
12.	Yuan SM, Shinfeld A, Raanani E. The Blalock-Taussig shunt. J Card Surg, 2009, 24 (2):101-108.
13.	Batra AS, Starnes VA, Wells WJ. Does the site of insertion of a sys-temic-pulmonary shunt influence growth of the pulmonary arteries. Ann Thorac Surg, 2005, 79 (2):636-640.
14.	张家俊, 王旭, 陈霞, 等.小儿体肺分流手术的围术期处理.中华胸心血管外科杂志, 2003, 19 (3):170-171.
15.	Freedom RM, Pongiglione G, Williams WG, et al. Palliative right ventricular outflow tract construction for patients with pulmonary atresia, ventricular septal defect, and hypoplastic pulmonary arteries. J Thorac Cardiovasc Surg, 1983, 86 (1):24-36.
16.	Dragulescu A, Kammache I, Fouilloux V, et al. Long-term results of pulmonary artery rehabilitation in patients with pulmonary atresia, ventricular septal defect, pulmonary artery hypoplasia, and major aortopulmonary collaterals. J Thorac Cardiovasc Surg, 2011, 142 (6):1374-1380.
17.	Korbmacher B, Heusch A, Sunderdiek U, et al. Evidence for palliative enlargement of the right ventricular outflow tract in severe tetralogy of Fallot. Eur J Cardiothorac Surg, 2005, 27 (6):945-948.
18.	Ogawa K, Hisano K, Shida T, et al. Construction of right ventri-cular outflow tract in pulmonary atresia and ventricular septal defect with poorly developed pulmonary arteries-as a palliative operation (author's transl). Nihon Kyobu Geka Gakkai Zasshi, 1981, 29 (1):98-102.
19.	邓喜成, 沈向东, 郭少先, 等.姑息手术在肺动脉闭锁合并室间隔缺损分期矫治中的应用.中国胸心血管外科临床杂志, 2011, 18 (2):104-108.
20.	Fouilloux V, Bonello B, Kammache I, et al. Management of pati-ents with pulmonary atresia, ventricular septal defect, hypoplastic pulmonary arteries and major aorto-pulmonary collaterals:Focus on the strategy of rehabilitation of the native pulmonary arteries. Arch Cardiovasc Dis, 2012, 105 (12):666-675.
21.	黄继红, 徐志伟, 苏肇伉, 等.肺动脉闭锁伴室间隔缺损患者姑息手术后血气与血流动力学指标的改变.中国胸心血管外科临床杂志, 2009, 16 (1):36-39.
22.	Agnoletti G, Boudjemline Y, Bonnet D, et al. Surgical Reconstruction of occluded pulmonary arteries in patients with congenital heart disease:effects on pulmonary artery growth. Circulation, 2004, 109 (19):2314-2318.
23.	郑景浩, 徐志伟, 苏肇伉, 等.小儿肺动脉闭锁伴室间隔缺损右室流出道重建方法.中华胸心血管外科杂志, 2005, 21 (5):257-259.
24.	Brawn WJ, Murala JS. Editorial comment:Reconstruction of the right ventricular outflow tract:short-term solutions, long-term problems. Eur J Cardiothorac Surg, 2012, 42 (2):233-234.
25.	Nakano T. Surgical strategy for pulmonary atresia with ventricular septal defect associated with severely hypoplastic or absent central pulmonary artery. Kyobu Geka, 2012, 65 (8):676-681.

1. 邓喜成, 李守军.肺动脉闭锁合并室间隔缺损的外科治疗策略.中国胸心血管外科临床杂志, 2010, 17 (1):50-54.
2. Murthy K, Reddy KP, Nagarajan R, et al. Management of ventricular septal defect with pulmonary atresia and major aorto pulmonary colla-teral arteries:Challenges and controversies. Ann Pediatr Cardiol, 2010, 3 (2):127-135.
3. Brizard CP, Liava'a M, d'Udekem Y. Pulmonary atresia, VSD and Mapcas:repair without unifocalization. Semin Thorac Cardiovasc Surg Pediatr Card Surg Annu, 2009, 12 (1):139-144.
4. Liava'a M, Brizard CP, Konstantinov IE, et al. Pulmonary atresia, ventricular septal defect, and major aortopulmonary collaterals:neon-atal pulmonary artery rehabilitation without unifocalization. Ann Thorac Surg, 2012, 93 (1):185-191.
5. Gerelli S, van Steenberghe M, Murtuza B, et al. Neonatal right vent-ricle to pulmonary connection as a palliative procedure for pulmonary atresia with ventricular septal defect or severe tetralogy of Fallot. Eur J Cardiothorac Surg, 2014, 45 (2):278-288.
6. Mumtaz MA, Rosenthal G, Qureshi A, et al. Melbourne shunt promotes growth of diminutive central pulmonary arteries in patients with pulmonary atresia, ventricular septal defect, and systemic topulmonary collateral arteries. Ann Thorac Surg, 2008, 85 (6):2079-2084.
7. Ahmad U, Fatimi SH, Naqvi I, et al. Modified Blalock-Taussig shunt:immediate and short-term follow-up results in neonates. Heart Lung Circ, 2008, 17 (1):54-58.
8. Mohammadi S, Benhameid O, Campbell A, et al. Could we still improve early and interim outcome after prosthetic systemic-pulmonary shunt? A risk factors analysis. Eur J Cardiothorac Surg, 2008, 34 (3):545-549.
9. Wells WJ, Yu RJ, Batra AS, et al. Obstruction in modified Blalock shunts:a quantitative analysis with clinical correlation. Ann Thorac Surg, 2005, 79 (6):2072-2076.
10. Gedicke M, Morgan G, Parry A, et al. Risk factors for acute shunt blockage in children after modified Blalock-Taussig shunt operations. Heart Vessels, 2010, 25 (5):405-409.
11. Ghanayem NS, Jaquiss RD, Cava JR, et al. Right ventricle-to-pulmonary artery conduit versus Blalock-Taussig shunt:a hemodynamic comparison. Ann Thorac Surg, 2006, 82 (5):1603-1610.
12. Yuan SM, Shinfeld A, Raanani E. The Blalock-Taussig shunt. J Card Surg, 2009, 24 (2):101-108.
13. Batra AS, Starnes VA, Wells WJ. Does the site of insertion of a sys-temic-pulmonary shunt influence growth of the pulmonary arteries. Ann Thorac Surg, 2005, 79 (2):636-640.
14. 张家俊, 王旭, 陈霞, 等.小儿体肺分流手术的围术期处理.中华胸心血管外科杂志, 2003, 19 (3):170-171.
15. Freedom RM, Pongiglione G, Williams WG, et al. Palliative right ventricular outflow tract construction for patients with pulmonary atresia, ventricular septal defect, and hypoplastic pulmonary arteries. J Thorac Cardiovasc Surg, 1983, 86 (1):24-36.
16. Dragulescu A, Kammache I, Fouilloux V, et al. Long-term results of pulmonary artery rehabilitation in patients with pulmonary atresia, ventricular septal defect, pulmonary artery hypoplasia, and major aortopulmonary collaterals. J Thorac Cardiovasc Surg, 2011, 142 (6):1374-1380.
17. Korbmacher B, Heusch A, Sunderdiek U, et al. Evidence for palliative enlargement of the right ventricular outflow tract in severe tetralogy of Fallot. Eur J Cardiothorac Surg, 2005, 27 (6):945-948.
18. Ogawa K, Hisano K, Shida T, et al. Construction of right ventri-cular outflow tract in pulmonary atresia and ventricular septal defect with poorly developed pulmonary arteries-as a palliative operation (author's transl). Nihon Kyobu Geka Gakkai Zasshi, 1981, 29 (1):98-102.
19. 邓喜成, 沈向东, 郭少先, 等.姑息手术在肺动脉闭锁合并室间隔缺损分期矫治中的应用.中国胸心血管外科临床杂志, 2011, 18 (2):104-108.
20. Fouilloux V, Bonello B, Kammache I, et al. Management of pati-ents with pulmonary atresia, ventricular septal defect, hypoplastic pulmonary arteries and major aorto-pulmonary collaterals:Focus on the strategy of rehabilitation of the native pulmonary arteries. Arch Cardiovasc Dis, 2012, 105 (12):666-675.
21. 黄继红, 徐志伟, 苏肇伉, 等.肺动脉闭锁伴室间隔缺损患者姑息手术后血气与血流动力学指标的改变.中国胸心血管外科临床杂志, 2009, 16 (1):36-39.
22. Agnoletti G, Boudjemline Y, Bonnet D, et al. Surgical Reconstruction of occluded pulmonary arteries in patients with congenital heart disease:effects on pulmonary artery growth. Circulation, 2004, 109 (19):2314-2318.
23. 郑景浩, 徐志伟, 苏肇伉, 等.小儿肺动脉闭锁伴室间隔缺损右室流出道重建方法.中华胸心血管外科杂志, 2005, 21 (5):257-259.
24. Brawn WJ, Murala JS. Editorial comment:Reconstruction of the right ventricular outflow tract:short-term solutions, long-term problems. Eur J Cardiothorac Surg, 2012, 42 (2):233-234.
25. Nakano T. Surgical strategy for pulmonary atresia with ventricular septal defect associated with severely hypoplastic or absent central pulmonary artery. Kyobu Geka, 2012, 65 (8):676-681.

Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Comparison of Early Clinical Outcomes between Systemic-Pulmonary Shunts and Right Ventricular to Pulmonary Artery Connection for Patients with Pulmonary Atresia and Ventricular Septal Defect

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