Featured Research

from universities, journals, and other organizations

In infant heart surgery, newer technique yields better survival in first year of life

Date:
May 28, 2010
Source:
Children's Hospital of Philadelphia
Summary:
Pediatric researchers report that a recently introduced surgical procedure offers infants with severely underdeveloped hearts a better chance at surviving during their first year of life, in comparison to the standard surgery.

Pediatric researchers report that a recently introduced surgical procedure offers infants with severely underdeveloped hearts a better chance at surviving during their first year of life, in comparison to the standard surgery.

Heart surgeons from 15 centers in the federally sponsored Pediatric Heart Network studied the outcomes in 549 newborns who received a complex series of surgeries for hypoplastic left heart syndrome (HLHS).

"This landmark study is the largest clinical trial ever performed in congenital heart surgery, and the first randomized trial comparing two surgical procedures for congenital heart defects," said senior author J. William Gaynor, M.D., a pediatric cardiothoracic surgeon at The Children's Hospital of Philadelphia, and co-principal investigator of the study. As one of the nation's leading programs in pediatric cardiology, the Cardiac Center at Children's Hospital enrolled 101 subjects in this study.

The study results appear in the May 27 issue of the New England Journal of Medicine.

The lead author and principal investigator of this study, called the Single Ventricle Reconstruction (SVR) Trial, was Richard G. Ohye, M.D., head of the Pediatric Cardiovascular Surgery Division of the University of Michigan.

Occurring about once in every 100 live births, congenital heart disease is the most common birth defect. It includes a broad variety of structural abnormalities, but HLHS is among the most severe forms. In HLHS, affecting 1 in 5,000 live births, the left ventricle, one of the heart's two pumping chambers, is small and unable to function. Without treatment, HLHS is fatal in the first few days of life.

Starting in the 1980s, surgeons developed surgical procedures for HLHS that have allowed increasingly more children born with a single functioning ventricle to survive. The intervention involves three planned surgeries, beginning in the newborn period and extending to 18 to 36 months of age.

The SVR trial reported in the current study compares two techniques used in the initial, riskiest stage of surgery, called the Norwood procedure. As part of the Norwood procedure, surgeons implant a shunt to reroute blood from the malformed heart to the pulmonary artery, which supplies the lungs.

The traditional surgical approach is to use a modified Blalock-Taussig (MBT) shunt, which carries blood from an artery branching off the aorta to the pulmonary artery. The newer technique, sometimes known as the Sano procedure or the right ventricle-pulmonary artery (RVPA) shunt, links the right ventricle to the pulmonary artery. If either technique fails, the only alternative is a heart transplant.

In the current trial, researchers randomized infants who required the Norwood procedure to two groups, 275 for the MBT shunt and 274 for the RVPA shunt. Twelve months after the surgery, 74 percent of infants with the RVPA shunt survived and didn't require a heart transplant, compared to 64 percent of infants with the MBT shunt. The RVPA group did, however, undergo a higher rate of complications requiring unintended interventions, such as needing stents or balloons to keep the shunt open. After the first year, rates for transplantation-free survival were the same for both groups.

The researchers will continue to follow the children in the study over a longer period to further analyze patient outcomes for the two types of shunts.

Beyond survival, patient outcomes include quality-of-life issues. As medical and surgical advances have improved survival rates for children born with heart defects, caregivers have been able to focus on long-term effects of their disease and its treatment. In particular, children with complex congenital heart disease (CHD) are at greater risk of neurodevelopmental problems. As these children reach school age, they tend to have higher rates of academic, behavioral and coordination difficulties compared to peers.

The Children's Hospital of Philadelphia is one of several centers that now have formalized programs to provide ongoing neurodevelopmental care for children with congenital heart disease. As a member of such a program and a leader in ongoing research on neurodevelopmental outcomes in CHD patients, Gaynor concluded, "It will be important to monitor these children as they grow and to not only make sure they are physically doing well but also hitting developmental milestones."

The National Heart, Lung and Blood Institute, part of the National Institutes of Health, provided funding support for this study through its sponsorship of the Pediatric Heart Network.


Story Source:

The above story is based on materials provided by Children's Hospital of Philadelphia. Note: Materials may be edited for content and length.


Journal Reference:

  1. Ohye et al. Comparison of Shunt Types in the Norwood Procedure for Single-Ventricle Lesions. New England Journal of Medicine, 2010; 362 (21): 1980 DOI: 10.1056/NEJMoa0912461

Cite This Page:

Children's Hospital of Philadelphia. "In infant heart surgery, newer technique yields better survival in first year of life." ScienceDaily. ScienceDaily, 28 May 2010. <www.sciencedaily.com/releases/2010/05/100527013327.htm>.
Children's Hospital of Philadelphia. (2010, May 28). In infant heart surgery, newer technique yields better survival in first year of life. ScienceDaily. Retrieved July 31, 2014 from www.sciencedaily.com/releases/2010/05/100527013327.htm
Children's Hospital of Philadelphia. "In infant heart surgery, newer technique yields better survival in first year of life." ScienceDaily. www.sciencedaily.com/releases/2010/05/100527013327.htm (accessed July 31, 2014).

Share This




More Health & Medicine News

Thursday, July 31, 2014

Featured Research

from universities, journals, and other organizations


Featured Videos

from AP, Reuters, AFP, and other news services

Health Insurers' Profits Slide

Health Insurers' Profits Slide

Reuters - Business Video Online (July 30, 2014) Obamacare-related costs were said to be behind the profit plunge at Wellpoint and Humana, but Wellpoint sees the new exchanges boosting its earnings for the full year. Fred Katayama reports. Video provided by Reuters
Powered by NewsLook.com
Concern Grows Over Worsening Ebola Crisis

Concern Grows Over Worsening Ebola Crisis

AFP (July 30, 2014) Pan-African airline ASKY has suspended all flights to and from the capitals of Liberia and Sierra Leone amid the worsening Ebola health crisis, which has so far caused 672 deaths in Guinea, Liberia and Sierra Leone. Duration: 00:43 Video provided by AFP
Powered by NewsLook.com
At Least 20 Chikungunya Cases in New Jersey

At Least 20 Chikungunya Cases in New Jersey

AP (July 30, 2014) At least 20 New Jersey residents have tested positive for chikungunya, a mosquito-borne virus that has spread through the Caribbean. (July 30) Video provided by AP
Powered by NewsLook.com
Xtreme Eating: Your Daily Caloric Intake All On One Plate

Xtreme Eating: Your Daily Caloric Intake All On One Plate

Newsy (July 30, 2014) The Center for Science in the Public Interest released its 2014 list of single meals with whopping calorie counts. Video provided by Newsy
Powered by NewsLook.com

Search ScienceDaily

Number of stories in archives: 140,361

Find with keyword(s):
Enter a keyword or phrase to search ScienceDaily for related topics and research stories.

Save/Print:
Share:

Breaking News:
from the past week

In Other News

... from NewsDaily.com

Science News

Health News

    Environment News

    Technology News



      Save/Print:
      Share:

      Free Subscriptions


      Get the latest science news with ScienceDaily's free email newsletters, updated daily and weekly. Or view hourly updated newsfeeds in your RSS reader:

      Get Social & Mobile


      Keep up to date with the latest news from ScienceDaily via social networks and mobile apps:

      Have Feedback?


      Tell us what you think of ScienceDaily -- we welcome both positive and negative comments. Have any problems using the site? Questions?
      Mobile: iPhone Android Web
      Follow: Facebook Twitter Google+
      Subscribe: RSS Feeds Email Newsletters
      Latest Headlines Health & Medicine Mind & Brain Space & Time Matter & Energy Computers & Math Plants & Animals Earth & Climate Fossils & Ruins