A comparison of the modified Blalock-Taussig shunt with the right ventricle-to-pulmonary artery conduit: A single center experience

Objectives: This study compared the modified Blalock-Taussig (MBT) shunt with the right ventricle-topulmonary artery (Sano) shunt with respect to outcome and PA growth and Interventions in stage I palliation of hypoplast left heart syndrome (HLHS).

Methods: This study reviews 75 neonates undergoing the Norwood procedure in the same interval between April 2002 and June 2012. The Sano (55) or MBT shunt (17) was assigned according to the surgeon's preference.

Results: The 30 days mortality was in Sano group was 11% and in MBT group 23%. Reintervention rate for pulmonary bifurcation or pulmonary arteries was significant higher in Sano group 35% vs. MBT group 17%. The branch PA growth was similar in both groups without any significant difference. (McGoon ratio: MBT, 1.55 ± 0.43 vs. RVPA, 1.73 ± 0.31). The Nakata index trended higher in MBT (MBT, 235.29 ± 102.67 mm2/m2 vs. RVPA, 207 ± 54.58 mm2/m2) without any significance. After stage 2 palliation, oxygen saturation trended higher in the Sano (81%± 5%) vs. MBT cohort (75%± 10%).

Conclusions: In our retrospective non-randomized study, the Norwood operation using a Sano shunt in our cohort was associated with lower mortality without any better improvement of branch PA growth. Sano shunt interventions occurred with increased numbers. The optimal shunt to improve survival to the second-stage palliation is unknown. A multicenter randomized clinical trial comparing the Sano with the MBT shunt in HLHS may provide future guidelines for shunt selection based on clinical presentation.