Periscopic technique in Norwood operation is associated with better preservation of early ventricular functionCentral MessagePerspective
Objective: Although the right ventricle (RV) to pulmonary artery conduit in stage 1 Norwood operation results in improved interstage survival, the long-term effects of the ventriculotomy used in the traditional technique remain a concern. The periscopic technique (PT) of RV to pulmonary artery condu...
Saved in:
| Main Authors: | , , , , , , , , , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
Elsevier
2021-08-01
|
| Series: | JTCVS Techniques |
| Subjects: | |
| Online Access: | http://www.sciencedirect.com/science/article/pii/S2666250721003801 |
| Tags: |
Add Tag
No Tags, Be the first to tag this record!
|
| _version_ | 1849765073597235200 |
|---|---|
| author | Puneet Bhatla, MD TK Susheel Kumar, MD Luv Makadia, MD Brandon Winston, MPH Catherine Bull, PNP-BC James C. Nielsen, MD David Williams, MD Sujata Chakravarti, MD Richard G. Ohye, MD Ralph S. Mosca, MD |
| author_facet | Puneet Bhatla, MD TK Susheel Kumar, MD Luv Makadia, MD Brandon Winston, MPH Catherine Bull, PNP-BC James C. Nielsen, MD David Williams, MD Sujata Chakravarti, MD Richard G. Ohye, MD Ralph S. Mosca, MD |
| author_sort | Puneet Bhatla, MD |
| collection | DOAJ |
| description | Objective: Although the right ventricle (RV) to pulmonary artery conduit in stage 1 Norwood operation results in improved interstage survival, the long-term effects of the ventriculotomy used in the traditional technique remain a concern. The periscopic technique (PT) of RV to pulmonary artery conduit placement has been described as an alternative technique to minimize RV injury. A retrospective study was performed to compare the effects of traditional technique and PT on ventricular function following Norwood operation. Methods: A retrospective study of all patients who underwent Norwood operation from 2012 to 2019 was performed. Patients with baseline RV dysfunction and significant tricuspid valve regurgitation were excluded. Prestage 2 echocardiograms were reviewed by a blinded experienced imager for quantification of RV function (sinus and infundibular RV fractional area change) as well as for regional conduit site wall dysfunction (normal or abnormal, including hypokinesia, akinesia, or dyskinesia). Wilcoxon rank-sum tests were used to assess differences in RV infundibular and RV sinus ejection fraction and the Fisher exact test was used to assess differences in regional wall dysfunction. Results: Twenty-two patients met inclusion criteria. Eight underwent traditional technique and 14 underwent PT. Median infundibular RV fractional area change was 49% and 37% (P = .02) and sinus RV fractional area change was 50% and 41% for PT and traditional technique (P = .007) respectively. Similarly qualitative regional RV wall function was better preserved in PT (P = .002). Conclusions: The PT for RV to pulmonary artery conduit in Norwood operation results in better preservation of early RV global and regional systolic function. Whether or not this benefit translates to improved clinical outcome still needs to be studied. |
| format | Article |
| id | doaj-art-d9625c4b11e243a7b214d4f8a07a0ece |
| institution | DOAJ |
| issn | 2666-2507 |
| language | English |
| publishDate | 2021-08-01 |
| publisher | Elsevier |
| record_format | Article |
| series | JTCVS Techniques |
| spelling | doaj-art-d9625c4b11e243a7b214d4f8a07a0ece2025-08-20T03:04:58ZengElsevierJTCVS Techniques2666-25072021-08-01811612310.1016/j.xjtc.2021.05.014Periscopic technique in Norwood operation is associated with better preservation of early ventricular functionCentral MessagePerspectivePuneet Bhatla, MD0TK Susheel Kumar, MD1Luv Makadia, MD2Brandon Winston, MPH3Catherine Bull, PNP-BC4James C. Nielsen, MD5David Williams, MD6Sujata Chakravarti, MD7Richard G. Ohye, MD8Ralph S. Mosca, MD9Division of Pediatric Cardiology, New York University Langone Medical Center, New York, NY; Department of Radiology, New York University Langone Medical Center, New York, NYDepartment of Cardiac Surgery, New York University Langone Medical Center, New York, NYDepartment of Pediatrics, New York University Langone Medical Center, New York, NYDepartment of Cardiac Surgery, New York University Langone Medical Center, New York, NYDepartment of Cardiac Surgery, New York University Langone Medical Center, New York, NYDivision of Pediatric Cardiology, New York University Langone Medical Center, New York, NYDepartment of Cardiac Surgery, New York University Langone Medical Center, New York, NYDivision of Pediatric Cardiology, New York University Langone Medical Center, New York, NYDepartment of Cardiac Surgery, Mott Children's Hospital, Ann Arbor, MichDepartment of Cardiac Surgery, New York University Langone Medical Center, New York, NY; Address for reprints: Ralph S. Mosca, MD, Department of Cardiac Surgery, NYU Langone Medical Center, 530 First Ave, Suite 9v, New York, NY 10016.Objective: Although the right ventricle (RV) to pulmonary artery conduit in stage 1 Norwood operation results in improved interstage survival, the long-term effects of the ventriculotomy used in the traditional technique remain a concern. The periscopic technique (PT) of RV to pulmonary artery conduit placement has been described as an alternative technique to minimize RV injury. A retrospective study was performed to compare the effects of traditional technique and PT on ventricular function following Norwood operation. Methods: A retrospective study of all patients who underwent Norwood operation from 2012 to 2019 was performed. Patients with baseline RV dysfunction and significant tricuspid valve regurgitation were excluded. Prestage 2 echocardiograms were reviewed by a blinded experienced imager for quantification of RV function (sinus and infundibular RV fractional area change) as well as for regional conduit site wall dysfunction (normal or abnormal, including hypokinesia, akinesia, or dyskinesia). Wilcoxon rank-sum tests were used to assess differences in RV infundibular and RV sinus ejection fraction and the Fisher exact test was used to assess differences in regional wall dysfunction. Results: Twenty-two patients met inclusion criteria. Eight underwent traditional technique and 14 underwent PT. Median infundibular RV fractional area change was 49% and 37% (P = .02) and sinus RV fractional area change was 50% and 41% for PT and traditional technique (P = .007) respectively. Similarly qualitative regional RV wall function was better preserved in PT (P = .002). Conclusions: The PT for RV to pulmonary artery conduit in Norwood operation results in better preservation of early RV global and regional systolic function. Whether or not this benefit translates to improved clinical outcome still needs to be studied.http://www.sciencedirect.com/science/article/pii/S2666250721003801NorwoodRV functionRV to PA conduitperiscopic techniqueechocardiography |
| spellingShingle | Puneet Bhatla, MD TK Susheel Kumar, MD Luv Makadia, MD Brandon Winston, MPH Catherine Bull, PNP-BC James C. Nielsen, MD David Williams, MD Sujata Chakravarti, MD Richard G. Ohye, MD Ralph S. Mosca, MD Periscopic technique in Norwood operation is associated with better preservation of early ventricular functionCentral MessagePerspective JTCVS Techniques Norwood RV function RV to PA conduit periscopic technique echocardiography |
| title | Periscopic technique in Norwood operation is associated with better preservation of early ventricular functionCentral MessagePerspective |
| title_full | Periscopic technique in Norwood operation is associated with better preservation of early ventricular functionCentral MessagePerspective |
| title_fullStr | Periscopic technique in Norwood operation is associated with better preservation of early ventricular functionCentral MessagePerspective |
| title_full_unstemmed | Periscopic technique in Norwood operation is associated with better preservation of early ventricular functionCentral MessagePerspective |
| title_short | Periscopic technique in Norwood operation is associated with better preservation of early ventricular functionCentral MessagePerspective |
| title_sort | periscopic technique in norwood operation is associated with better preservation of early ventricular functioncentral messageperspective |
| topic | Norwood RV function RV to PA conduit periscopic technique echocardiography |
| url | http://www.sciencedirect.com/science/article/pii/S2666250721003801 |
| work_keys_str_mv | AT puneetbhatlamd periscopictechniqueinnorwoodoperationisassociatedwithbetterpreservationofearlyventricularfunctioncentralmessageperspective AT tksusheelkumarmd periscopictechniqueinnorwoodoperationisassociatedwithbetterpreservationofearlyventricularfunctioncentralmessageperspective AT luvmakadiamd periscopictechniqueinnorwoodoperationisassociatedwithbetterpreservationofearlyventricularfunctioncentralmessageperspective AT brandonwinstonmph periscopictechniqueinnorwoodoperationisassociatedwithbetterpreservationofearlyventricularfunctioncentralmessageperspective AT catherinebullpnpbc periscopictechniqueinnorwoodoperationisassociatedwithbetterpreservationofearlyventricularfunctioncentralmessageperspective AT jamescnielsenmd periscopictechniqueinnorwoodoperationisassociatedwithbetterpreservationofearlyventricularfunctioncentralmessageperspective AT davidwilliamsmd periscopictechniqueinnorwoodoperationisassociatedwithbetterpreservationofearlyventricularfunctioncentralmessageperspective AT sujatachakravartimd periscopictechniqueinnorwoodoperationisassociatedwithbetterpreservationofearlyventricularfunctioncentralmessageperspective AT richardgohyemd periscopictechniqueinnorwoodoperationisassociatedwithbetterpreservationofearlyventricularfunctioncentralmessageperspective AT ralphsmoscamd periscopictechniqueinnorwoodoperationisassociatedwithbetterpreservationofearlyventricularfunctioncentralmessageperspective |