Related Experiment Video
Updated: Aug 5, 2026
Implantation of Total Artificial Heart in Congenital Heart Disease
Published on: July 18, 2014
First-stage palliation of complex univentricular cardiac anomalies in older infants
B W Duncan1, G L Rosenthal, T K Jones
1Department of Pediatrics, Children's Hospital and Regional Medical Center, and the University of Washington School of Medicine, Seattle, USA. duncanb@ccf.org
Insights
First-stage surgical palliation for infants over 30 days with complex congenital heart defects shows comparable outcomes to neonates. Utilizing a larger shunt may improve results for these challenging pediatric cardiac cases.
Area of Science:
- Pediatric Cardiology
- Congenital Heart Surgery
- Neonatal Intensive Care
Background:
- Historically, infants older than 30 days with complex cardiac anomalies have had poor outcomes following first-stage palliation.
- This study addresses the outcomes of a policy extending first-stage palliation to all eligible patients regardless of age.
Purpose of the Study:
- To evaluate the effectiveness and outcomes of first-stage surgical palliation in infants older than 30 days with complex congenital heart disease.
- To determine if outcomes in this older infant group are comparable to those typically seen in neonates.
Main Methods:
- Retrospective review of patients older than 30 days who underwent first-stage palliation.
- Procedures included Norwood or Damus-Kaye-Stancel with a modified Blalock-Taussig shunt.
- Subsequent procedures like bidirectional Glenn and Fontan reconstruction were analyzed.
Main Results:
- Nine patients (median age 67 days) with conditions like hypoplastic left heart syndrome underwent palliation, with all surviving the initial operation.
- Eight patients proceeded to bidirectional Glenn, with 6 survivors.
- Two survivors have completed Fontan reconstruction, and four are awaiting it.
Conclusions:
- First-stage surgical palliation is feasible and yields comparable results in older infants (over 30 days) with complex univentricular cardiac malformations compared to neonates.
- The use of a larger modified Blalock-Taussig shunt may be a contributing factor to the improved outcomes observed in this cohort.
Background:
Poor outcomes have been reported for children older than 30 days of age with cardiac anomalies treated with first-stage palliation.
Methods:
Our institution has offered first-stage palliation for all such patients regardless of age. The results of this policy were reviewed.
Results:
Nine patients older than 30 days (median age 67 days, range 36 to 108 days) with diagnoses of hypoplastic left heart syndrome (n = 5), double-outlet right ventricle with hypoplastic aortic arch (n = 2), unbalanced atrioventricular septal defect (n = 1), or single left ventricle with subaortic stenosis (n = 1) underwent surgical palliation. Patients underwent a Norwood (n = 7) or Damus-Kaye-Stancel (n = 2) procedure with a 4- or 5-mm modified Blalock-Taussig shunt; all patients survived the operation. Eight patients underwent a subsequent bidirectional Glenn (2 perioperative deaths, both due to pneumonia; 6 survivors). Two of the 6 surviving patients have undergone Fontan reconstruction and 4 are awaiting Fontan.
Conclusions:
Surgical palliation for complex univentricular cardiac malformations can be performed in older infants with results comparable to those in neonates. The use of a larger shunt may contribute to these improved outcomes.
More Related Videos
13:10Direct Re-implantation of Left Coronary Artery into the Aorta in Adults with Anomalous Origin of Left Coronary Artery from the Pulmonary Artery (ALCAPA)
Published on: April 24, 2017
11:27A Modified Sonographic Algorithm for Image Acquisition in Life-Threatening Emergencies in the Critically Ill Newborn
Published on: April 7, 2023
Related Concept Videos
01:30Cardiomyopathy II: Dilated Cardiomyopathy
01:29Cardiomyopathy V: Interprofessional Care