Boston - American Association for Thoracic Surgery

89 TH ANNUAL MEETING MAY 9–MAY 13, 2009BOSTON, MASSACHUSETTS25. A Contemporary Comparison of the Effect of Shunt Type inHypoplastic Left Heart Syndrome on the Hemodynamics andOutcome at Fontan CompletionJean A. Ballweg, 1 Troy E. Dominguez, 1 Chitra Ravishankar, 1 Peter J. Gruber, 1Gil Wernovsky, 1 J.W. Gaynor, 1* Susan C. Nicolson, 1 Thomas L. Spray, 1* Sarah Tabbutt 21. Children’s Hospital of Philadelphia, Philadelphia, PA, USA; 2. University ofCalifornia San Francisco, San Francisco, CA, USAInvited Discussant: Christian PizarroOBJECTIVE: We previously reported no difference in morbidity or mortality ininfants undergoing stage 1 and stage 2 reconstruction with either a modified BTshunt (mBTS) or a right ventricular to pulmonary artery conduit (RV-PA). We nowcompare the hemodynamics and peri-operative course at the time of the Fontancompletion and report longer-term survival.METHODS: We retrospectively reviewed the echocardiograms, catheterizationsand hospital records of all patients who previously underwent stage 1 reconstruction(S1R) between January 2002 and May 2005 and subsequent surgical procedures,as well as cross-sectional analysis of hospital survivors.RESULTS: 176 pts with HLHS and variants underwent initial S1R with eithermBTS (n = 114) or RV-PA conduit (n = 62). The median duration of follow-up was53 months (range 1–76). By Kaplan-Meier analysis, shunt type did not influencesurvival or freedom from transplant at 5 years (RV-PA 61%, 95% CL: 47–72% vs.mBTS 70%, 95% CL: 60–77%, p = 0.55). Nintey three pts underwent Fontan (62mBTS and 31 RV-PA) with 98% (91/93) early survival. Pre-Fontan there was a trendtowards higher pulmonary artery pressure (13 ± 8 mmHg vs. 11 ± 3 mmHg, p =0.05) and common atrial pressure (8 ± 2 mmHg vs. 7 ± 2 mmHg, p = 0.06) in ptswith RV-PA conduits. By echo evaluation, there was a trend towards more qualitativemoderate to severe ventricular dysfunction (RV-PA 31% (11/35) vs. mBTS 17%(11/65), p = 0.08) and moderate to severe atrioventricular valve regurgitation (RV-PA38% (13/34) vs. mBTS 17% (11/65), p = 0.07) in the RV-PA group. Use of diuretictherapy, ACE inhibition, reflux medications and tube feedings were no differentbetween groups. There was a trend towards increased digoxin use in the RV-PAgroup (RV-PA 71% (25/35) vs. 65% mBTS (45/69), p = 0.06). Overall 5 pts underwentheart transplantation (RV-PA 4 vs. mBTS 1, p = 0.1) prior to Fontan. Therewas no difference in age or weight at Fontan, bypass time, ICU or hospital lengthof stay, post-operative pleural effusions or need for reoperation between groups.CONCLUSION: Interim analyses continue to suggest that there is no advantageof one shunt type over another. Longer term follow-up of a randomized patientpopulation remains of utmost importance.3:20 p.m. INTERMISSION – VISIT EXHIBITSExhibit Hall* AATS Member114