Key result
The RV-PA shunt was associated with significantly lower mortality at 1 year (26.6% vs 28.6%) and 2 years compared to the mBT shunt, as well as lower overall complications (8.5% vs 17.8%).
Why the study?
It remained uncertain whether the modified Blalock-Taussig shunt or the right ventricle-to-pulmonary artery shunt confers better morbidity and mortality in patients with hypoplastic left heart syndrome or its variants undergoing the Norwood procedure.
Does the RV-PA shunt reduce mortality and complications compared to the modified Blalock-Taussig shunt in patients with hypoplastic left heart syndrome undergoing the Norwood procedure?
Meta-Analysis
Does the RV-PA shunt reduce mortality and complications compared to the modified Blalock-Taussig shunt in patients with hypoplastic left heart syndrome undergoing the Norwood procedure?
In patients with hypoplastic left heart syndrome undergoing the Norwood procedure, the RV-PA shunt is associated with lower short-term mortality (1-2 years) and overall complications compared to the mBT shunt, though long-term mortality is similar and RV-PA shunt has higher early cardiac complications.
Supports preferring RV-PA over mBT shunt in Norwood for lower short-term mortality; extends prior trials via meta-analytic synthesis.
Background In the Norwood procedure, a conduit is performed either from the subclavian artery to the pulmonary artery, Blalock–Taussig shunt (mBTs), or from the right ventricle to the pulmonary artery (RV‐PA shunt). There are some concerns regarding the two shunts and which one is better according to morbidity and mortality in patients with hypoplastic left heart syndrome or its variants. Methods We systematically searched PubMed, Web of Science, Scopus, Embase, and Cochrane Library databases from inception to 04/June/2021 to collect articles reporting a comparison of RV‐PA shunt and mBTs. Results Our meta‐analysis showed that the mortality rate after 6 months, 1, 2, 3, 4, 5, and 6 years for the mBTS group was 16.3%, 28.6%, 34.8%, 42.4%, 44.6%, 45.1%, and 39.6%, respectively, and for the RV‐PAS, 14.8%, 26.6%, 31%, 40.1%, 36.1%, 37.5%, and 34.0%, respectively. The mortality rate was significantly higher in the mBTs group at 1 and 2 years; otherwise, there is no significance differences. Overall complications rate was higher in the mBTs group than in the RV‐PAs group (17.8% vs. 8.5%). In contrast, the rate of cardiac complications was higher in the RV‐PAS group. Conclusions The RV‐PA shunt had lower mortality and overall complications rate than mBT shunt at the short‐term outcome within the first two years, but at the long term, there was no difference between the two shunts. On the other hand, the mBT shunt had a lower incidence of cardiac complications at the early stage after the operations. However, some studies are poor due to the difficulties in conducting original research in this field. Therefore, we recommend conducting systematic reviews and original studies to compare these and other therapeutic procedures for these patients.
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Arnaout et al. (2023) conducted a meta-analysis in Hypoplastic left heart syndrome or its variants. Right ventricle to pulmonary artery (RV-PA) shunt vs. Modified Blalock-Taussig shunt (mBTs) was evaluated on Mortality rate at 1 year. The RV-PA shunt was associated with significantly lower mortality at 1 year (26.6% vs 28.6%) and 2 years compared to the mBT shunt, as well as lower overall complications (8.5% vs 17.8%).
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