• Richard G Ohye, Lynn A Sleeper, Lynn Mahony, Jane W Newburger, Gail D Pearson, Minmin Lu, Caren S Goldberg, Sarah Tabbutt, Peter C Frommelt, Nancy S Ghanayem, Peter C Laussen, John F Rhodes, Alan B Lewis, Seema Mital, Chitra Ravishankar, Ismee A Williams, Carolyn Dunbar-Masterson, Andrew M Atz, Steven Colan, L LuAnn Minich, Christian Pizarro, Kirk R Kanter, James Jaggers, Jeffrey P Jacobs, Catherine Dent Krawczeski, Nancy Pike, Brian W McCrindle, Lisa Virzi, J William Gaynor, and Pediatric Heart Network Investigators.
• University of Michigan Medical School, Ann Arbor, MI, USA. ohye@umich.edu
• N. Engl. J. Med. 2010 May 27;362(21):1980-92.

BackgroundThe Norwood procedure with a modified Blalock-Taussig (MBT) shunt, the first palliative stage for single-ventricle lesions with systemic outflow obstruction, is associated with high mortality. The right ventricle-pulmonary artery (RVPA) shunt may improve coronary flow but requires a ventriculotomy. We compared the two shunts in infants with hypoplastic heart syndrome or related anomalies.MethodsInfants undergoing the Norwood procedure were randomly assigned to the MBT shunt (275 infants) or the RVPA shunt (274 infants) at 15 North American centers. The primary outcome was death or cardiac transplantation 12 months after randomization. Secondary outcomes included unintended cardiovascular interventions and right ventricular size and function at 14 months and transplantation-free survival until the last subject reached 14 months of age.ResultsTransplantation-free survival 12 months after randomization was higher with the RVPA shunt than with the MBT shunt (74% vs. 64%, P=0.01). However, the RVPA shunt group had more unintended interventions (P=0.003) and complications (P=0.002). Right ventricular size and function at the age of 14 months and the rate of nonfatal serious adverse events at the age of 12 months were similar in the two groups. Data collected over a mean (+/-SD) follow-up period of 32+/-11 months showed a nonsignificant difference in transplantation-free survival between the two groups (P=0.06). On nonproportional-hazards analysis, the size of the treatment effect differed before and after 12 months (P=0.02).ConclusionsIn children undergoing the Norwood procedure, transplantation-free survival at 12 months was better with the RVPA shunt than with the MBT shunt. After 12 months, available data showed no significant difference in transplantation-free survival between the two groups. (ClinicalTrials.gov number, NCT00115934.)2010 Massachusetts Medical Society

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