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Norwood Operation with Right Ventricular–Pulmonary Artery Shunt Versus Comprehensive Stage II After Bilateral Pulmonary Artery Banding Palliation

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Abstract

As a strategy for the primary Norwood operation, the right ventricular–pulmonary artery shunt is associated with satisfactory early outcome. However, use of this shunt after bilateral pulmonary artery banding remains controversial. This study compared the operative outcomes and late hemodynamics in patients who underwent the Norwood operation, preceded by bilateral pulmonary artery banding, with a right ventricular–pulmonary artery shunt or with bidirectional Glenn anastomosis (comprehensive stage II strategy). We retrospectively reviewed 38 patients who underwent the Norwood operation preceded by bilateral pulmonary artery banding between 2004 and 2017. Of these, 17 underwent the Norwood operation with a right ventricular–pulmonary artery shunt (Group S), whereas 21 underwent the comprehensive stage II strategy (Group G). 5 years after the Norwood operation, 10 (60%) and 17 (81%) patients in Group S and Group G, respectively, underwent the Fontan procedure. Group S showed significantly lower pressure in the superior vena cava after bidirectional Glenn anastomosis than Group G (13 ± 2 mmHg vs. 18 ± 3 mmHg; p < 0.01), but pressures were similar after the Fontan procedure. The right ventricular end-diastolic volume at 1 year post-Fontan procedure was significantly higher in Group S than in Group G (142 ± 41% vs. 91 ± 28%; p < 0.01). In terms of early outcomes, the Norwood operation with a right ventricular–pulmonary artery shunt enabled low pressure in the superior vena cava, but in the long term, this shunt adversely influenced the right ventricular volume.

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Abbreviations

RV–PA:

Right ventricular–pulmonary artery

HLHS:

Hypoplastic left heart syndrome

BDG:

Bidirectional Glenn anastomosis

bPAB:

Bilateral pulmonary artery banding

SVC:

Superior vena cava

PAI:

Pulmonary artery index

PA:

Pulmonary artery

PTPA:

Percutaneous transcatheter pulmonary angioplasty

TCPC:

Total cavopulmonary connection

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Acknowledgements

The authors thank Editage (www.editage.jp) for English language editing.

Funding

This research received no specific grant from any funding agency in the public, commercial, or not-for-profit sectors.

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Authors and Affiliations

  1. Department of Cardiovascular Surgery, Osaka Women’s and Children’s Hospital, 840 Murodocho, Izumi, Osaka, 594-1101, Japan

    Koji Miwa, Shigemitsu Iwai, Tomomitsu Kanaya & Shota Kawai

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  1. Koji Miwa
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  2. Shigemitsu Iwai
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  3. Tomomitsu Kanaya
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  4. Shota Kawai
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Contributions

Conceptualization: KM and SI; methodology: SI; review and editing: TK and SK.

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Correspondence to Koji Miwa.

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The authors declare no competing interest.

Ethical Approval

Ethics approval for this study was obtained from the Ethics Committee and Institutional Review Board Committee of Osaka Women’s and Children’s Hospital (approval no.: 1478; approval date: November 19, 2021).

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The requirement for obtaining written informed consent was waived due to the retrospective design of the study.

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Miwa, K., Iwai, S., Kanaya, T. et al. Norwood Operation with Right Ventricular–Pulmonary Artery Shunt Versus Comprehensive Stage II After Bilateral Pulmonary Artery Banding Palliation. Pediatr Cardiol 45, 943–952 (2024). https://doi.org/10.1007/s00246-023-03258-y

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