Surgical management of competing pulmonary blood flow affects survival before Fontan/Kreutzer completion in @entity1 with XXXX .

@entity1 @entity2597 @entity1145 @entity358 @entity1146
OBJECTIVES: To determine the association between surgical management of pulmonary blood flow (PBF) at initial and staged procedures with survival to Fontan/Kreutzer operation (Fontan) in @entity1 with @entity1145 . METHODS: @entity1 aged <3  months with @entity1145 (n  =  303) were enrolled from 34 institutions (1999-2013). Among those who underwent surgical intervention (n  =  302), initial procedures were: @entity358 ( @entity358 ; n  =  189; 62%); pulmonary artery banding (PAB; n  =  50; 17%); and @entity2597 ( @entity2597 ; n  =  63; 21%). Multiphase parametric-hazard models were used to analyze competing outcomes. RESULTS: Risk-adjusted 6-year survival was lower after @entity358 (85%; P  =  .04) versus PAB (93%) or @entity2597 (93%). Survival after @entity358 when the main pulmonary artery (MPA) was closed (n  =  21) or banded (n  =  4) was 60%, versus 93% without MPA intervention (P  =  .02). After @entity358 , survival before @entity2597 was lower with an open ductus arteriosus (n  =  7; 76% vs 97%; P  =  .02). Similarly, after @entity358 , risk-adjusted survival was similar to that for @entity1 who had an initial PAB or @entity2597 when MPA intervention was avoided and the ductus arteriosus either closed spontaneously before @entity358 , or was closed during @entity358 . For all @entity1 reaching @entity2597 (n  =  277), survival to Fontan was not significantly influenced by whether PBF persisted through the MPA. CONCLUSIONS: Tricuspid @entity1146 @entity1 with @entity358 represent a high-risk subgroup. Avoiding an open ductus arteriosus and concomitant MPA intervention during @entity358 may help mitigate the risk associated with @entity358 . The presence of antegrade PBF through the MPA, at initial and staged operations, did not significantly influence survival to Fontan operation.
