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  • Title: [Surgical strategy and the results for hypoplastic left heart syndrome].
    Author: Nakano T, Kado H, Tatewaki H, Hinokiyama K, Machida D, Ebuoka N, Shoujima T, Ikarashi J.
    Journal: Kyobu Geka; 2014 Apr; 67(4):299-304. PubMed ID: 24917160.
    Abstract:
    OBJECTIVE: We retrospectively reviewed our surgical results in patients with hypoplastic left heart syndrome( HLHS) to investigate the influence of surgical strategy on outcome. METHODS: Seventy-seven patients with classic HLHS were involved in this study. For the initial palliation, 23 patients underwent Norwood operation with modified Blalock-Taussig (BT) shunt, 23 patients underwent Norwood operation with right ventricle to pulmonary artery( RV-PA) shunt and 31 patients underwent bilateral pulmonary artery banding (BPAB). Surgical results, freedom from Fontan operation, hemodynamic data and incidence of complication after Fontan operation were compared between the 3 groups. RESULTS: BPAB group had more preoperative risk factors than Norwood group. Total actuarial survival was 62.4% at 1 year and 58.2% at 3 and 5 years, and there was no difference between the groups. Freedom from Fontan completion was 59.4% at 3 years and 48.7% at 5 years without difference between the groups. The incidence of intervention for pulmonary artery stenosis was higher in Norwood with RV-PA shunt group(52.9%). Hemodynamic data obtained by cardiac catheterization were similar in the 3 groups, however, end-systolic elastance, which represents ventricular contractility, was lower in Norwood with RV-PA group. CONCLUSIONS: Surgical results of Norwood with BT shunt and Norwood with RV-PA shunt were comparably satisfactory, however, there was possible concern of reduced ventricular contractility in RV-PA shunt group. BPAB was a effective and useful initial palliation in high risk cases.
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