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

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 was 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.