Impact of pre-stage II hemodynamics and pulmonary artery anatomy on 12-month outcomes in the Pediatric Heart Network Single Ventricle Reconstruction trial

Ranjit Aiyagari, John F. Rhodes, Peter Shrader, Wolfgang A. Radtke, Varsha M. Bandisode, Lisa Bergersen, Matthew J. Gillespie, Robert G. Gray, Lin T. Guey, Kevin D. Hill, Russel Hirsch, Dennis W. Kim, Kyong Jin Lee, Andrew N Pelech, Jeremy Ringewald, Cheryl Takao, Julie A. Vincent, Richard G. Ohye

Research output: Contribution to journalArticle

11 Citations (Scopus)

Abstract

Objective: To compare the interstage cardiac catheterization hemodynamic and angiographic findings between shunt types for the Pediatric Heart Network Single Ventricle Reconstruction trial. The trial, which randomized subjects to a modified Blalock-Taussig shunt (MBTS) or right ventricle-to-pulmonary artery shunt (RVPAS) for the Norwood procedure, demonstrated the RVPAS was associated with a smaller pulmonary artery diameter but superior 12-month transplant-free survival.

Methods: We analyzed the pre-stage II catheterization data for the trial subjects. The hemodynamic variables and shunt and pulmonary angiographic data were compared between shunt types; their association with 12-month transplant-free survival was also evaluated.

Results: Of 549 randomized subjects, 389 underwent pre-stage II catheterization. A smaller size, lower aortic and superior vena cava saturation, and higher ventricular end-diastolic pressure were associated with worse 12- month transplant-free survival. The MBTS group had a lower coronary perfusion pressure (27 vs 32 mm Hg; P.001) and greater pulmonary blood flow/systemic blood flow ratio (1.1 vs 1.0, P = .009). A greater pulmonary blood flow/systemic blood flow ratio increased the risk of death or transplantation only in the RVPAS group (P=.01). The MBTS group had fewer shunt (14%vs 28%, P=.004) and severe left pulmonary artery (0.7%vs 9.2%, P = .003) stenoses, larger mid-main branch pulmonary artery diameters, and greater Nakata indexes (164 vs 134, P < .001).

Conclusions: Compared with the RVPAS subjects, the MBTS subjects had more hemodynamic abnormalities related to shunt physiology, and the RVPAS subjects had more shunt or pulmonary obstruction of a severe degree and inferior pulmonary artery growth at pre-stage II catheterization. A lower body surface area, greater ventricular end-diastolic pressure, and lower superior vena cava saturation were associated with worse 12-month transplant-free survival.

Original languageEnglish (US)
Pages (from-to)1467-1474
Number of pages8
JournalJournal of Thoracic and Cardiovascular Surgery
Volume148
Issue number4
DOIs
StatePublished - Oct 1 2014
Externally publishedYes

Fingerprint

Pulmonary Artery
Anatomy
Hemodynamics
Pediatrics
Blalock-Taussig Procedure
Heart Ventricles
Catheterization
Transplants
Lung
Superior Vena Cava
Norwood Procedures
Blood Pressure
Body Surface Area
Cardiac Catheterization
Pathologic Constriction
Perfusion
Transplantation
Odds Ratio
Pressure
Growth

ASJC Scopus subject areas

  • Surgery
  • Pulmonary and Respiratory Medicine
  • Cardiology and Cardiovascular Medicine

Cite this

Impact of pre-stage II hemodynamics and pulmonary artery anatomy on 12-month outcomes in the Pediatric Heart Network Single Ventricle Reconstruction trial. / Aiyagari, Ranjit; Rhodes, John F.; Shrader, Peter; Radtke, Wolfgang A.; Bandisode, Varsha M.; Bergersen, Lisa; Gillespie, Matthew J.; Gray, Robert G.; Guey, Lin T.; Hill, Kevin D.; Hirsch, Russel; Kim, Dennis W.; Lee, Kyong Jin; Pelech, Andrew N; Ringewald, Jeremy; Takao, Cheryl; Vincent, Julie A.; Ohye, Richard G.

In: Journal of Thoracic and Cardiovascular Surgery, Vol. 148, No. 4, 01.10.2014, p. 1467-1474.

Research output: Contribution to journalArticle

Aiyagari, R, Rhodes, JF, Shrader, P, Radtke, WA, Bandisode, VM, Bergersen, L, Gillespie, MJ, Gray, RG, Guey, LT, Hill, KD, Hirsch, R, Kim, DW, Lee, KJ, Pelech, AN, Ringewald, J, Takao, C, Vincent, JA & Ohye, RG 2014, 'Impact of pre-stage II hemodynamics and pulmonary artery anatomy on 12-month outcomes in the Pediatric Heart Network Single Ventricle Reconstruction trial', Journal of Thoracic and Cardiovascular Surgery, vol. 148, no. 4, pp. 1467-1474. https://doi.org/10.1016/j.jtcvs.2013.10.057
Aiyagari, Ranjit ; Rhodes, John F. ; Shrader, Peter ; Radtke, Wolfgang A. ; Bandisode, Varsha M. ; Bergersen, Lisa ; Gillespie, Matthew J. ; Gray, Robert G. ; Guey, Lin T. ; Hill, Kevin D. ; Hirsch, Russel ; Kim, Dennis W. ; Lee, Kyong Jin ; Pelech, Andrew N ; Ringewald, Jeremy ; Takao, Cheryl ; Vincent, Julie A. ; Ohye, Richard G. / Impact of pre-stage II hemodynamics and pulmonary artery anatomy on 12-month outcomes in the Pediatric Heart Network Single Ventricle Reconstruction trial. In: Journal of Thoracic and Cardiovascular Surgery. 2014 ; Vol. 148, No. 4. pp. 1467-1474.
@article{25560030e9be4c4d90b82ba7531f5558,
title = "Impact of pre-stage II hemodynamics and pulmonary artery anatomy on 12-month outcomes in the Pediatric Heart Network Single Ventricle Reconstruction trial",
abstract = "Objective: To compare the interstage cardiac catheterization hemodynamic and angiographic findings between shunt types for the Pediatric Heart Network Single Ventricle Reconstruction trial. The trial, which randomized subjects to a modified Blalock-Taussig shunt (MBTS) or right ventricle-to-pulmonary artery shunt (RVPAS) for the Norwood procedure, demonstrated the RVPAS was associated with a smaller pulmonary artery diameter but superior 12-month transplant-free survival.Methods: We analyzed the pre-stage II catheterization data for the trial subjects. The hemodynamic variables and shunt and pulmonary angiographic data were compared between shunt types; their association with 12-month transplant-free survival was also evaluated.Results: Of 549 randomized subjects, 389 underwent pre-stage II catheterization. A smaller size, lower aortic and superior vena cava saturation, and higher ventricular end-diastolic pressure were associated with worse 12- month transplant-free survival. The MBTS group had a lower coronary perfusion pressure (27 vs 32 mm Hg; P.001) and greater pulmonary blood flow/systemic blood flow ratio (1.1 vs 1.0, P = .009). A greater pulmonary blood flow/systemic blood flow ratio increased the risk of death or transplantation only in the RVPAS group (P=.01). The MBTS group had fewer shunt (14{\%}vs 28{\%}, P=.004) and severe left pulmonary artery (0.7{\%}vs 9.2{\%}, P = .003) stenoses, larger mid-main branch pulmonary artery diameters, and greater Nakata indexes (164 vs 134, P < .001).Conclusions: Compared with the RVPAS subjects, the MBTS subjects had more hemodynamic abnormalities related to shunt physiology, and the RVPAS subjects had more shunt or pulmonary obstruction of a severe degree and inferior pulmonary artery growth at pre-stage II catheterization. A lower body surface area, greater ventricular end-diastolic pressure, and lower superior vena cava saturation were associated with worse 12-month transplant-free survival.",
author = "Ranjit Aiyagari and Rhodes, {John F.} and Peter Shrader and Radtke, {Wolfgang A.} and Bandisode, {Varsha M.} and Lisa Bergersen and Gillespie, {Matthew J.} and Gray, {Robert G.} and Guey, {Lin T.} and Hill, {Kevin D.} and Russel Hirsch and Kim, {Dennis W.} and Lee, {Kyong Jin} and Pelech, {Andrew N} and Jeremy Ringewald and Cheryl Takao and Vincent, {Julie A.} and Ohye, {Richard G.}",
year = "2014",
month = "10",
day = "1",
doi = "10.1016/j.jtcvs.2013.10.057",
language = "English (US)",
volume = "148",
pages = "1467--1474",
journal = "Journal of Thoracic and Cardiovascular Surgery",
issn = "0022-5223",
publisher = "Mosby Inc.",
number = "4",

}

TY - JOUR

T1 - Impact of pre-stage II hemodynamics and pulmonary artery anatomy on 12-month outcomes in the Pediatric Heart Network Single Ventricle Reconstruction trial

AU - Aiyagari, Ranjit

AU - Rhodes, John F.

AU - Shrader, Peter

AU - Radtke, Wolfgang A.

AU - Bandisode, Varsha M.

AU - Bergersen, Lisa

AU - Gillespie, Matthew J.

AU - Gray, Robert G.

AU - Guey, Lin T.

AU - Hill, Kevin D.

AU - Hirsch, Russel

AU - Kim, Dennis W.

AU - Lee, Kyong Jin

AU - Pelech, Andrew N

AU - Ringewald, Jeremy

AU - Takao, Cheryl

AU - Vincent, Julie A.

AU - Ohye, Richard G.

PY - 2014/10/1

Y1 - 2014/10/1

N2 - Objective: To compare the interstage cardiac catheterization hemodynamic and angiographic findings between shunt types for the Pediatric Heart Network Single Ventricle Reconstruction trial. The trial, which randomized subjects to a modified Blalock-Taussig shunt (MBTS) or right ventricle-to-pulmonary artery shunt (RVPAS) for the Norwood procedure, demonstrated the RVPAS was associated with a smaller pulmonary artery diameter but superior 12-month transplant-free survival.Methods: We analyzed the pre-stage II catheterization data for the trial subjects. The hemodynamic variables and shunt and pulmonary angiographic data were compared between shunt types; their association with 12-month transplant-free survival was also evaluated.Results: Of 549 randomized subjects, 389 underwent pre-stage II catheterization. A smaller size, lower aortic and superior vena cava saturation, and higher ventricular end-diastolic pressure were associated with worse 12- month transplant-free survival. The MBTS group had a lower coronary perfusion pressure (27 vs 32 mm Hg; P.001) and greater pulmonary blood flow/systemic blood flow ratio (1.1 vs 1.0, P = .009). A greater pulmonary blood flow/systemic blood flow ratio increased the risk of death or transplantation only in the RVPAS group (P=.01). The MBTS group had fewer shunt (14%vs 28%, P=.004) and severe left pulmonary artery (0.7%vs 9.2%, P = .003) stenoses, larger mid-main branch pulmonary artery diameters, and greater Nakata indexes (164 vs 134, P < .001).Conclusions: Compared with the RVPAS subjects, the MBTS subjects had more hemodynamic abnormalities related to shunt physiology, and the RVPAS subjects had more shunt or pulmonary obstruction of a severe degree and inferior pulmonary artery growth at pre-stage II catheterization. A lower body surface area, greater ventricular end-diastolic pressure, and lower superior vena cava saturation were associated with worse 12-month transplant-free survival.

AB - Objective: To compare the interstage cardiac catheterization hemodynamic and angiographic findings between shunt types for the Pediatric Heart Network Single Ventricle Reconstruction trial. The trial, which randomized subjects to a modified Blalock-Taussig shunt (MBTS) or right ventricle-to-pulmonary artery shunt (RVPAS) for the Norwood procedure, demonstrated the RVPAS was associated with a smaller pulmonary artery diameter but superior 12-month transplant-free survival.Methods: We analyzed the pre-stage II catheterization data for the trial subjects. The hemodynamic variables and shunt and pulmonary angiographic data were compared between shunt types; their association with 12-month transplant-free survival was also evaluated.Results: Of 549 randomized subjects, 389 underwent pre-stage II catheterization. A smaller size, lower aortic and superior vena cava saturation, and higher ventricular end-diastolic pressure were associated with worse 12- month transplant-free survival. The MBTS group had a lower coronary perfusion pressure (27 vs 32 mm Hg; P.001) and greater pulmonary blood flow/systemic blood flow ratio (1.1 vs 1.0, P = .009). A greater pulmonary blood flow/systemic blood flow ratio increased the risk of death or transplantation only in the RVPAS group (P=.01). The MBTS group had fewer shunt (14%vs 28%, P=.004) and severe left pulmonary artery (0.7%vs 9.2%, P = .003) stenoses, larger mid-main branch pulmonary artery diameters, and greater Nakata indexes (164 vs 134, P < .001).Conclusions: Compared with the RVPAS subjects, the MBTS subjects had more hemodynamic abnormalities related to shunt physiology, and the RVPAS subjects had more shunt or pulmonary obstruction of a severe degree and inferior pulmonary artery growth at pre-stage II catheterization. A lower body surface area, greater ventricular end-diastolic pressure, and lower superior vena cava saturation were associated with worse 12-month transplant-free survival.

UR - http://www.scopus.com/inward/record.url?scp=84908236610&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=84908236610&partnerID=8YFLogxK

U2 - 10.1016/j.jtcvs.2013.10.057

DO - 10.1016/j.jtcvs.2013.10.057

M3 - Article

C2 - 24332668

AN - SCOPUS:84908236610

VL - 148

SP - 1467

EP - 1474

JO - Journal of Thoracic and Cardiovascular Surgery

JF - Journal of Thoracic and Cardiovascular Surgery

SN - 0022-5223

IS - 4

ER -