• Clifford L Cua, Ravi R Thiagarajan, Kimberlee Gauvreau, Lillian Lai, John M Costello, David L Wessel, Pedro J Del Nido, John E Mayer, Jane W Newburger, and Peter C Laussen.
• Department of Cardiology, Children's Hospital, Boston, MA, USA.
• Pediatr Crit Care Me. 2006 May 1;7(3):238-44.

ObjectivePrevious publications using nonconcurrent series of patients indicate improved survival for patients with hypoplastic left heart syndrome (HLHS) undergoing stage I palliation with a right ventricle to pulmonary artery conduit (NW-RVPA) vs. a modified Blalock-Taussig shunt (NW-BT). We compared postoperative outcomes in a concurrent series of patients with HLHS undergoing an NW-BT procedure vs. NW-RVPA procedure.DesignPerioperative data from 66 consecutive patients who underwent NW-BT (n = 37) or NW-RVPA (n = 29) procedures were retrospectively analyzed.SettingCardiac intensive care unit in a tertiary pediatric hospital.PatientsCharts were reviewed for all patients with the diagnosis of HLHS undergoing the NW-BT or NW-RVPA procedure between January 2002 and December 2003.ResultsCardiopulmonary bypass time was longer in the NW-BT group than in the NW-RVPA group (152.5 +/- 52.0 vs. 134.5 +/- 36.1 mins; p = .04). Postoperative diastolic pressures were higher and the Pao2 to Fio2 ratio profiles were lower for the NW-RVPA group over the first 72 hrs. Time to sternal closure (2 [1-6] vs. 4 [2-41] days; p = .01), duration of mechanical ventilation (113 [49-386] vs. 136 [84-764] hrs; p = .01), time to establish enteral feeds (4 [2-8] vs. 5 [3-22] days; p = .01), length of intensive care unit stay (11 [7-55] vs. 15 [8-90] days; p = .04), and length of hospital stay (16 [11-67] vs. 27 [12-126] days; p = .01) were shorter in the NW-RVPA group. Postoperative mortality was not significantly different between the NW-RVPA group (7%) and NW-BT group (11%).ConclusionAt an experienced institution with low stage I palliation mortality for HLHS, there were no differences in early morbidity and mortality between the NW-RVPA and NW-BT procedures. The primary advantage of the NW-RVPA procedure may be faster recovery following surgery and earlier discharge from the hospital.

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