Reinforced Cardiac Shunt Helps Repair Serious Heart Defect
By HospiMedica International staff writers Posted on 07 Jul 2015 |
A new study shows that using a ring-reinforced shunt improves surgical outcomes in children born with hypoplastic left heart syndrome (HLHS).
Researchers at Boston Children’s Hospital (MA, USA) and Harvard Medical School (Boston, MA, USA) conducted a retrospective review of 87 patients with HLHS who underwent Norwood Stage-1 surgery. Of these, 48 patients received the standard, non-reinforced Gore-Tex right-ventricle-to-pulmonary-artery (RV-PA) conduit, and 39 received the same conduit, but reinforced with rings. The -reinforced graft was placed through a limited ventriculotomy. Primary and secondary outcomes were survival and need for cardiac re-intervention up to age 12 months.
The results showed that a ring-reinforced conduit was associated with reduced intervention, as well as higher pulse pressures and improved pulmonary artery (PA) growth. There was no difference in transplant-free survival by age 12 months, but those with the non-reinforced grafts had more interventions during their first year (69% versus 35%, respectively). Survival to discharge after the first stage Norwood surgery was 98% in the ring-reinforced group, compared with 83% in the non-reinforced group. In addition, survival at 12 months was higher in the ring-reinforced group (92% versus 75%). The study was published in the June 2015 issue of the Journal of Thoracic and Cardiovascular Surgery.
“The technique of using a ring-reinforced graft in conjunction with a limited right ventricular incision has theoretic advantages in preserving right ventricular function,” said lead author Audrey Marshall, MD, of the department of cardiology. “The ring-reinforced conduit maintains a uniform interior passageway for blood flow.”
“Although avoiding the use of a non-reinforced conduit may seem to be a minor adjustment in technique, the potential for important long-term patient benefit cannot be disregarded,” said Charles Fraser Jr., MD, of Texas Children's Hospital (Houston, USA) in an editorial commentary. “While the journey toward staged HLHS palliation was begun several decades ago and there have been many steps, it remains an arduous journey. Even a small step of progress encourages further focus.”
HLHS is a congenital defect in which the left side of the heart does not develop properly, impairing normal circulation. Children with this condition undergo a series of three reconstructive surgeries, called the Norwood Procedure, to help restore oxygenated blood flow. The first stage attempts to permit the normally functioning right ventricle to pump blood to both the lungs and the body. The second stage, the Bi-directional Glenn Shunt Procedure, follows when the infant is between four and six months old. The third step is the Fontan Procedure, which is carried out between 18 months to three years of age. Since only about 50% of children survive this three-part surgical series after five years, surgeons are always looking for ways to improve outcomes.
Related Links:
Boston Children’s Hospital
Harvard Medical School
Researchers at Boston Children’s Hospital (MA, USA) and Harvard Medical School (Boston, MA, USA) conducted a retrospective review of 87 patients with HLHS who underwent Norwood Stage-1 surgery. Of these, 48 patients received the standard, non-reinforced Gore-Tex right-ventricle-to-pulmonary-artery (RV-PA) conduit, and 39 received the same conduit, but reinforced with rings. The -reinforced graft was placed through a limited ventriculotomy. Primary and secondary outcomes were survival and need for cardiac re-intervention up to age 12 months.
The results showed that a ring-reinforced conduit was associated with reduced intervention, as well as higher pulse pressures and improved pulmonary artery (PA) growth. There was no difference in transplant-free survival by age 12 months, but those with the non-reinforced grafts had more interventions during their first year (69% versus 35%, respectively). Survival to discharge after the first stage Norwood surgery was 98% in the ring-reinforced group, compared with 83% in the non-reinforced group. In addition, survival at 12 months was higher in the ring-reinforced group (92% versus 75%). The study was published in the June 2015 issue of the Journal of Thoracic and Cardiovascular Surgery.
“The technique of using a ring-reinforced graft in conjunction with a limited right ventricular incision has theoretic advantages in preserving right ventricular function,” said lead author Audrey Marshall, MD, of the department of cardiology. “The ring-reinforced conduit maintains a uniform interior passageway for blood flow.”
“Although avoiding the use of a non-reinforced conduit may seem to be a minor adjustment in technique, the potential for important long-term patient benefit cannot be disregarded,” said Charles Fraser Jr., MD, of Texas Children's Hospital (Houston, USA) in an editorial commentary. “While the journey toward staged HLHS palliation was begun several decades ago and there have been many steps, it remains an arduous journey. Even a small step of progress encourages further focus.”
HLHS is a congenital defect in which the left side of the heart does not develop properly, impairing normal circulation. Children with this condition undergo a series of three reconstructive surgeries, called the Norwood Procedure, to help restore oxygenated blood flow. The first stage attempts to permit the normally functioning right ventricle to pump blood to both the lungs and the body. The second stage, the Bi-directional Glenn Shunt Procedure, follows when the infant is between four and six months old. The third step is the Fontan Procedure, which is carried out between 18 months to three years of age. Since only about 50% of children survive this three-part surgical series after five years, surgeons are always looking for ways to improve outcomes.
Related Links:
Boston Children’s Hospital
Harvard Medical School
Latest Surgical Techniques News
- Miniaturized Ultrasonic Scalpel Enables Faster and Safer Robotic-Assisted Surgery
- AI Assisted Reading Tool for Small Bowel Video Capsule Endoscopy Detects More Lesions
- First-Ever Contact Force Pulsed Field Ablation System to Transform Treatment of Ventricular Arrhythmias
- Caterpillar Robot with Built-In Steering System Crawls Easily Through Loops and Bends
- Tiny Wraparound Electronic Implants to Revolutionize Treatment of Spinal Cord Injuries
- Small, Implantable Cardiac Pump to Help Children Awaiting Heart Transplant
- Gastrointestinal Imaging Capsule a Game-Changer in Esophagus Surveillance and Treatment
- World’s Smallest Laser Probe for Brain Procedures Facilitates Ablation of Full Range of Targets
- Artificial Intelligence Broadens Diagnostic Abilities of Conventional Coronary Angiography
- AI-Powered Surgical Visualization Tool Supports Surgeons' Visual Recognition in Real Time
- Cutting-Edge Robotic Bronchial Endoscopic System Provides Prompt Intervention during Emergencies
- Handheld Device for Fluorescence-Guided Surgery a Game Changer for Removal of High-Grade Glioma Brain Tumors
- Porous Gel Sponge Facilitates Rapid Hemostasis and Wound Healing
- Novel Rigid Endoscope System Enables Deep Tissue Imaging During Surgery
- Robotic Nerve ‘Cuffs’ Could Treat Various Neurological Conditions
- Flexible Microdisplay Visualizes Brain Activity in Real-Time To Guide Neurosurgeons