Stage I palliation for hypoplastic left heart syndrome: Is a right ventricle to pulmonary artery conduit associated with improved outcomes? Critical appraisal of Cua et al: 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 (Pediatr Crit Care Med 2006; 7:238-244)

Abstract

Objective: To review the findings and discuss the implications of studies comparing Norwood procedure with either modified Blalock-Taussig shunt (NW-BT) or right ventricle to pulmonary artery conduit (NW-RVPA) in stage I palliation of hypoplastic left heart syndrome (HLHS).

Design: A critical appraisal of "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" by Cua et al. (Pediatr Crit Care Med 2006; 7:238-244) with literature review.

Findings: Several retrospective studies using historical controls have reported improved results with NW-RVPA compared with NW-BT for stage I palliation of HLHS. The study by Cua et al. is one of a few recent articles with concurrent series that have found no difference in early postoperative mortality or morbidity, although in comparison with the NW-BT group, the NW-RVPA group had significantly shorter duration of mechanical ventilation, decreased length of intensive care unit stay and hospital stay, and shorter time to sternal closure and to establishment of enteral feeds.

Conclusions: NW-RVPA has theoretical advantages over NW-BT and is associated with excellent outcome results. However, available data are insufficient to prove benefit in terms of mortality or morbidity. A multicenter randomized trial is currently being conducted, which should provide more conclusive information.