Open Access
Thorac Cardiovasc Surg 2017; 65(S 01): S1-S110
DOI: 10.1055/s-0037-1598660
Oral Presentations
Sunday, February 12, 2017
DGTHG and DGPK: Univentricular Circulations
Georg Thieme Verlag KG Stuttgart · New York

Staged Palliation for Single Ventricle Physiology: The Influence of Specialization and Shunt Type

V. Fischer
1   Department of Pediatric Cardiac Surgery, Universität Erlangen-Nürnberg, Erlangen, Germany
,
C. Gall
2   Department of Medical Informatics, Biometry and Epidemiology, Universität Erlangen-Nürnberg, Erlangen, Germany
,
A. Purbojo
1   Department of Pediatric Cardiac Surgery, Universität Erlangen-Nürnberg, Erlangen, Germany
,
A. Rüffer
1   Department of Pediatric Cardiac Surgery, Universität Erlangen-Nürnberg, Erlangen, Germany
,
S. Dittrich
3   Department of Pediatric Cardiology, Universität Erlangen-Nürnberg, Erlangen, Germany
,
R. Cesnjevar
1   Department of Pediatric Cardiac Surgery, Universität Erlangen-Nürnberg, Erlangen, Germany
› Institutsangaben
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Publikationsverlauf

Publikationsdatum:
03. Februar 2017 (online)

 
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    Objectives: Retrospective analysis of surgical outcomes for single ventricle patients after staged palliation. Identification and analysis of risk factors.

    Methods: Between January 2000 and December 2014, a total of 213 patients underwent staged single ventricle palliation at our institution. The cohort was divided in two eras: era 1 from 2000–2007 (109 patients) and era 2 from 2008–2014 (104 patients). As part of the Norwood procedure, a modified BT-Shunt was primarily implanted in era 1, whereas a RV-PA-Shunt (Sano-Shunt) was used more often in era 2. Apart from this, cohorts did not differ in patient characteristics and procedures. The study population consists of 118 patients with dominant right ventricle, 78 with dominant left ventricle and 17 with Heterotaxia. Cox regression was performed to assess risk factors according to first palliative surgery type.

    Results: In era 2, a significant (p = 0.019) improved survival of the complete study cohort compared with era 1 (77 vs. 58%, 75 vs. 56%, and 66 vs. 51% after 1, 2 and 5 years) was achieved. Patients with dominant left ventricle showed an overall beneficial survival, which is even improved in era 2. Early and late attrition in era 1 was mainly influenced by patients with hypoplastic left heart syndrome after staged Norwood palliation. Analysis of Norwood patients showed a significantly positive effect of RV-PA Shunts compared with BT-Shunts (p = 0.00355) and identified a postoperative ECMO requirement as a major risk factor (p < 0.001). Longer bypass and clamping times in era 2 were tolerated to achieve satisfactory surgical results.

    Conclusion: Specialization and cumulative experience have influenced surgical outcomes for single ventricle patients over time. Application of RV-PA-Shunts (Sano-Shunt) instead of BT-Shunts whenever possible seemed to be of major influence for improved outcomes in hypoplastic left heart syndrome.


     

    Die Autoren geben an, dass kein Interessenkonflikt besteht.

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