Open Access

ARTICLE

The Norwood with Blalock-Taussig-Thomas Shunt—Worth a Second Look?

by Manasa Gadiraju^1,*, Dhaval Chauhan², Alexandra Schray³, James E. O’Brien Jr.^1,4, Edo Kwaku Setsoafia Bedzra^1,4

1 School of Medicine, University of Missouri-Kansas City, Kansas City, MO 64108, USA
2 Department of Cardiovascular and Thoracic Surgery, Division of Pediatric Cardiothoracic Surgery, West Virginia University, Morgantown, WV 26506, USA
3 Department of Surgery, Parkview Health, Fort Wayne, IN 46845, USA
4 Department of Surgery, Division of Congenital Cardiac Surgery, Children’s Mercy Hospital, Kansas City, MO 64108, USA

* Corresponding Author: Manasa Gadiraju. Email:

Congenital Heart Disease 2024, 19(5), 435-443. https://doi.org/10.32604/chd.2025.059705

Received 15 October 2024; Accepted 17 December 2024; Issue published 31 December 2024

Abstract

Background: Shunt repair for the Norwood procedure with either the right ventricle to pulmonary artery shunt (RVPAS) or the modified Blalock-Taussig-Thomas Shunt (BTTS) varies by institution and surgeon preference. Shunt choice has been informed by landmark trials including the Single Ventricle Reconstruction trial and modern outcomes data may engender future complementary studies. Methods: We conducted a retrospective analysis of all patients who underwent the Norwood procedure from 2014–2022 at a single center to compare outcomes by shunt type. The primary outcome measure was freedom from death or transplant. Secondary outcome measures included hospital length of stay, complications, and unplanned interventions. Results: 93 patients underwent the Norwood procedure at a median age of 7 days (IQR 5, 9) and 39 weeks gestation (IQR 38, 39). 67.7% had hypoplastic left heart syndrome. 39 patients received a BTTS compared to 54 RVPAS. There was no difference in operative mortality (BTTS 12.8%, RVPAS 9.3%, p = 0.58), death or transplant at 1 year (BTTS 15.4%, RVPAS 7.4%, p = 0.31), or between 1 and 3 years (BTTS 0%, RVPAS 5.6%, p = 0.26). There was a significantly higher rate of pulmonary arterial stenting in the RVPAS group (BTTS 1.21/100 patient-years, RVPAS 15.68/100 patient-years, p = 0.01). Conclusions: Similar short- and medium-term survival were seen in BTTS and RVPAS groups with fewer pulmonary artery interventions for BTTS, though our study is underpowered to suggest superior freedom from interventions. These results may serve as a hypothesis-generating study to revisit the SVR trial with a modern cohort in the setting of improved surgical technique and perioperative management.

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