Second stage after initial hybrid palliation for XXXX : Arterial or venous shunt?

@entity1 @entity1699
OBJECTIVE: Hybrid palliation for @entity1699 has been developed as an alternative to neonatal Norwood surgery. At the second stage, a source of pulmonary blood flow has to be established. Options include an arterial modified Blalock-Taussig or a venous superior cavopulmonary shunt. METHODS: We retrospectively reviewed @entity1 who received second-stage palliation after the initial hybrid. @entity1 were stratified according to the source of pulmonary blood supply into the arterial shunt (n  =  17 @entity1 ) or venous shunt (n  =  26 @entity1 ). RESULTS: Age and weight at second stage were lower in the arterial group (85 [45-268] days vs 152.5 [61-496] days, P  =  .001 and 3.6 [2.7-9.4] kg vs 5.1 [2.97-9.4] kg, P  =  .001, respectively). All recorded surgical times were shorter in the arterial group. Mechanical ventilation and intensive care stay were shorter in the venous group (5.82 [2.01-14.9] days vs 2.42 [0.56-13.67] days, P  =  .005 and 8.5 [3.6-23.7] vs 5.75 [0.8-17.6] days, P  =  .036, respectively) There was no difference in mortality (2/17 vs 5/26; P  =  .685) or incidence of complications between the 2 groups. There was a tendency toward a higher need for intervention in the immediate postoperative period in the venous group, but this did not reach significance (6/17 vs 13/26, P  =  .342). The arterial group has shown better development of the branch pulmonary arteries with a higher lower lobe index (158.38    39.43 mm(2)/m(2) vs 113.33    43.96 mm(2)/m(2), respectively, P  =  .037). CONCLUSIONS: Both arterial and venous shunts are viable options with mortality and morbidity results comparable to those in the literature. The arterial shunt pathway (2-stage Norwood I) may offer better pulmonary arterial growth than  the venous shunt (comprehensive/combined Norwood I and II).
