Síndrome do coração esquerdo hipoplásico: Estratégia cirúrgica e comparação de resultados com técnicas de Norwood x Sano

Abstract

Objectives: To report a surgical strategy for the Norwood procedure in hypoplastic left heart syndrome (HLHS) that enables short hypothermic circulatory arrest and aortic arch reconstruction using autologous pericardium. Additionally, the work compares the results of the modified Blalock-Taussig (mBT) shunt and the right ventricle-to-pulmonary artery (RV-PA) conduit procedures as the source of pulmonary blood flow. Method: A retrospective study was performed of 78 newborns consecutively operated on between March 1999 and June 2006. One technique to reconstruct the neoaorta and two different techniques, to reestablish the pulmonary blood flow, were utilized - mBT shunts in the first 37 newborns and RV-PA conduits in the last 41. Cannulation of the ductus arteriosus for systemic perfusion was the main part of the surgical strategy used to reduce the hypothermic circulatory arrest time. Results: In-hospital survival for the entire cohort was 74.35%, or 67.57% for the mBT shunt and 80.49% for the RVPA conduit Groups (p=0.21). Hypothermic circulatory arrest times were 45.79 ± 1.99 minutes and 36.8 ± 1.52 minutes (p=0.0012), respectively. Mortality rates between first and second stages were 40% for the mBT shunt and 6.9% for the RV-PA conduit Groups (p=0.007). Late coarctation of the aorta occurred in five patients. A comparison of the actuarial survival curves (Kaplan-Meier) showed that the results were better with the VD-AP conduit (p=0.003). Conclusions: This surgical strategy resulted in a short circulatory arrest time, low mortality and a low incidence of aortic coarctation. Although the higher rate of survival in the first palliation stage with the RV-PA conduit was not significant, the lower interstage mortality and superior medium-term survival in the RV-AP Group were statistically advantageous.