Design and rationale of a randomized trial comparing the Blalock-Taussig and right ventricle-pulmonary artery shunts in the Norwood procedure
Richard G Ohye, J William Gaynor, Nancy S Ghanayem, Caren S Goldberg, Peter C Laussen, Peter C Frommelt, Jane W Newburger, Gail D Pearson, Sarah Tabbutt, Gil Wernovsky, Lisa M Wruck, Andrew M Atz, Steve D Colan, James Jaggers, Brian W McCrindle, Ashwin Prakash, Michael D Puchalski, Lynn A Sleeper, Mario P Stylianou, Lynn Mahony, Pediatric Heart Network Investigators, Gail Pearson, Victoria Pemberton, Rae-Ellen Kavey, Judith Massicot-Fisher, Marsha Mathis, Mario Stylianou, Lynn Mahony, Lynn Sleeper, Steven D Colan, Patty Connell, Victoria Murtov, Lisa Wruck, Lisa Virzi, David F Teitel, Jane Newburger, Peter Laussen, Pedro del Nido, Roger Breitbart, Jami Levine, Ellen McGrath, Carolyn Dunbar-Masterson, Daphne Hsu, Ashwin Prakash, Ralph Mosca, Darlene Servedio, Victoria L Vetter, Sarah Tabbutt, J William Gaynor, Marisa Nolan, Stephanie Piacentino, D Woodrow Benson, Catherine Dent, Lois Bogenschutz, Teresa Barnard, Page A W Anderson, Piers Barker, James Jaggers, Charlie Sang Jr, Wesley Covitz, Theodore Koutlas, Ming Xu, Lori Jo Sutton, Kari Crawford, J Philip Saul, Andrew Atz, Scott Bradley, Eric Graham, Girish Shirali, Teresa Atz, LuAnn Minich, Michael Pulchalski, John Hawkins, Ruth Mestas, Marian Sharrow, Brian McCrindle, Joel Kirsh, Chris Caldarone, Elizabeth Radojewski, Susan McIntyre, Richard G Ohye, Caren S Goldberg, Cheryl Nowak, Nancy Ghanayem, James Tweddell, Kathy Mussatto, Michele Frommelt, Lisa Young-Borkowski, Alan Lewis, Vaughn Starnes, Nancy Pike, Jeff Jacobs, James Huhta, Tina Merola, Kirk Kanter, William Mahle, Joel Bond, Christian Pizarro, Carol Prospero, Tia Tortoriello, Deborah McElroy, Deborah Town, John Rhodes, Peter Frommelt, Gerald Marx, Catherine Stolle, Michael Artman, Erle Austin, Timothy Feltes, Julie Johnson, Thomas Klitzner, Jeffrey Krischer, G Paul Matherne, John Kugler, David J Driscoll, Mark Galantowicz, Sally A Hunsberger, Thomas J Knight, Holly Taylor, Catherine L Webb, Richard G Ohye, J William Gaynor, Nancy S Ghanayem, Caren S Goldberg, Peter C Laussen, Peter C Frommelt, Jane W Newburger, Gail D Pearson, Sarah Tabbutt, Gil Wernovsky, Lisa M Wruck, Andrew M Atz, Steve D Colan, James Jaggers, Brian W McCrindle, Ashwin Prakash, Michael D Puchalski, Lynn A Sleeper, Mario P Stylianou, Lynn Mahony, Pediatric Heart Network Investigators, Gail Pearson, Victoria Pemberton, Rae-Ellen Kavey, Judith Massicot-Fisher, Marsha Mathis, Mario Stylianou, Lynn Mahony, Lynn Sleeper, Steven D Colan, Patty Connell, Victoria Murtov, Lisa Wruck, Lisa Virzi, David F Teitel, Jane Newburger, Peter Laussen, Pedro del Nido, Roger Breitbart, Jami Levine, Ellen McGrath, Carolyn Dunbar-Masterson, Daphne Hsu, Ashwin Prakash, Ralph Mosca, Darlene Servedio, Victoria L Vetter, Sarah Tabbutt, J William Gaynor, Marisa Nolan, Stephanie Piacentino, D Woodrow Benson, Catherine Dent, Lois Bogenschutz, Teresa Barnard, Page A W Anderson, Piers Barker, James Jaggers, Charlie Sang Jr, Wesley Covitz, Theodore Koutlas, Ming Xu, Lori Jo Sutton, Kari Crawford, J Philip Saul, Andrew Atz, Scott Bradley, Eric Graham, Girish Shirali, Teresa Atz, LuAnn Minich, Michael Pulchalski, John Hawkins, Ruth Mestas, Marian Sharrow, Brian McCrindle, Joel Kirsh, Chris Caldarone, Elizabeth Radojewski, Susan McIntyre, Richard G Ohye, Caren S Goldberg, Cheryl Nowak, Nancy Ghanayem, James Tweddell, Kathy Mussatto, Michele Frommelt, Lisa Young-Borkowski, Alan Lewis, Vaughn Starnes, Nancy Pike, Jeff Jacobs, James Huhta, Tina Merola, Kirk Kanter, William Mahle, Joel Bond, Christian Pizarro, Carol Prospero, Tia Tortoriello, Deborah McElroy, Deborah Town, John Rhodes, Peter Frommelt, Gerald Marx, Catherine Stolle, Michael Artman, Erle Austin, Timothy Feltes, Julie Johnson, Thomas Klitzner, Jeffrey Krischer, G Paul Matherne, John Kugler, David J Driscoll, Mark Galantowicz, Sally A Hunsberger, Thomas J Knight, Holly Taylor, Catherine L Webb
Abstract
Objective: The initial palliative procedure for patients born with hypoplastic left heart syndrome and related single right ventricle anomalies, the Norwood procedure, remains among the highest risk procedures in congenital heart surgery. The classic Norwood procedure provides pulmonary blood flow with a modified Blalock-Taussig shunt. Improved outcomes have been reported in a few small, nonrandomized studies of a modification of the Norwood procedure that uses a right ventricle-pulmonary artery shunt to provide pulmonary blood flow. Other nonrandomized studies have shown no differences between the two techniques.
Methods: The Pediatric Heart Network designed a randomized clinical trial to compare outcomes for subjects undergoing a Norwood procedure with either the right ventricle-pulmonary artery or modified Blalock-Taussig shunt. Infants with a diagnosis of single, morphologically right ventricle anomaly who are undergoing a Norwood procedure are eligible for inclusion in this study. The primary outcome is death or cardiac transplant 12 months after random assignment. Secondary outcomes include postoperative morbidity after Norwood and stage II palliation procedures, right ventricular function and pulmonary arterial growth at stage II palliation, and neurodevelopmental outcomes at 14 months old. Incidence of adverse events will also be compared between treatment groups.
Conclusion: This study will make an important contribution to the care of patients with hypoplastic left heart syndrome and related forms of single, morphologically right ventricle. It also establishes a model with which other operative interventions for patients with congenital cardiovascular malformations can be evaluated in the future.
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Source: PubMed