Impact of initial Norwood shunt type on young @entity1699 XXXX listed for heart transplant: A multi-institutional study.

@entity1 @entity1699 @entity204 @entity5033
BACKGROUND: Pulmonary blood flow during Stage 1 (Norwood) palliation for @entity1699 ( @entity1699 ) is achieved via @entity5033 ( @entity5033 ) or right ventricle to pulmonary artery conduit (RVPA). Controversy exists regarding the differential impact of shunt type on outcome among those who require transplantation early in life. In this study we explored waitlist and post-transplant outcomes within this sub-population stratified by shunt type. METHODS: Eligible @entity1 were enrolled through the Pediatric Heart Transplant Study (PHTS) database. @entity1 included those listed for heart transplantation at 1 of 35 participating centers, all of whom were <6 years of age and with a diagnosis of @entity1699 (and variants) status post Stage 1 palliation with @entity5033 or RVPA. Standard risk factors for @entity204 were analyzed using multivariable hazards modeling. RESULTS: Between 2010 and 2013, 190 @entity1 were identified. Compared with the RVPA group (n = 111), the @entity5033 group (n = 79) was less likely to have undergone a Glenn palliation (41% vs 73%, p < 0.001), were younger at listing (median age 1.3 vs 1.8 years, p = 0.05), had lower median weight (7.9 vs 9.4 kg, p = 0.02), and were more likely to be mechanically ventilated at listing (35% vs 22%, p = 0.04). There were no significant differences in median waitlist time (1.7 vs 2.6 months, p = 0.2) or rate of transplantation (61% vs 60%, p = 1.0). Among waitlisted @entity1 , 3-month survival was less for @entity5033 compared with RVPA @entity1 (74% vs 91%, p = 0.02). @entity1 who had not yet achieved Glenn palliation before listing had lower waitlist 3-month survival (76% vs 90%, p = 0.02). In @entity5033 @entity1 <1 year old, there was a trend toward improved survival in those with Glenn palliation compared to those without (100% vs 68%, p = 0.08). Early post-transplant mortality rates were similar between the RVPA and @entity5033 groups (p = 0.4) with overall survival 84% at 1 year. CONCLUSIONS: Among @entity1699 @entity1 , the need for transplant before Glenn palliation is associated with poorer waitlist survival. Waitlist survival is poorer in the @entity5033 group, with this difference driven by pre-Glenn @entity5033 @entity1 . Post-transplant outcomes were unaffected by shunt type.
