Cardiac Intensive Care Early postoperative outcomes in a series of infants with hypoplastic left heart syndrome undergoing stage I palliation operation with either modified Blalock-Taussig shunt or right ventricle to pulmonary artery conduit*

Survival of infants with hypoplastic left heart syndrome (HLHS) and related singleventricle cardiac defects undergoing stage I palliation operation with a modified Blalock-Taussig shunt (NWBT) has improved over recent years. This can be attributed to improvements in diagnostic techniques; preoperative, intraoperative, and postoperative care; and better understanding of the risks factors associated with mortality among these patients (1–7). Despite an overall decrease in mortality with the stage I palliation operation, early mortality with this procedure varies considerably between institutions (1, 4, 6, 8, 9). A recent modification of the stage I palliation procedure, using a right ventricle to pulmonary artery conduit (NWRVPA) to provide pulmonary blood flow rather than the modified Blalock-Taussig shunt, has been reported by several congenital heart centers to improve early mortality among patients with singleventricle defects undergoing stage I palliation (10–16). The improved mortality among patients undergoing the NWRVPA operation has been explained in part by the absence of diastolic blood flow from the systemic circulation into the pulmonary circulation, resulting in better coronary and end-organ perfusion (10–12, 14, 15, 17). Whereas reports of diminished early mortality with the NW-RVPA procedure are compelling, the studies have not been randomized and have relied on historical controls. Although the improved early mortality has been ascribed to the use of the RV-PA conduit, the results of these studies are confounded by the use of historical controls, which may have been subjected to different perioperative management strategies, and higher mortality in an earlier era. We hypothesized that patients with HLHS undergoing the NWRVPA procedure would have better survival and outcomes than those undergoSee also p. 286. From the Departments of Cardiology (CLC, RRT, KG, LL, JMC, DLW, JWN, PCL) and Cardiac Surgery (PJdN, JEM), Children’s Hospital, Boston; and the Departments of Pediatrics (CLC, RRT, KG, LL, JMC, DLW, JWN, PCL) and Surgery (PJdN, JEM), Harvard Medical School, Boston, MA. The authors report no conflict of interest. Presented in part at the Annual Meeting of the American Heart Association, 2004. Copyright © 2006 by the Society of Critical Care Medicine and the World Federation of Pediatric Intensive and Critical Care Societies