Valved Sano Shunt Improves Immediate Outcomes Following Norwood Operation for Hypoplastic Left Heart Syndrome

Hypoplastic left heart syndrome (HLHS) is a birth defect that affects normal blood flow through the heart. As the baby develops during pregnancy, the left side of the heart does not form correctly. The Centers for Disease Control and Prevention (CDC) estimates that each year about 1,025 babies in the United States are born with hypoplastic left heart syndrome—about one out of every 3,841 babies each year. 

Although HLHS outcomes have improved tremendously with staged surgical palliation and the technical and management refinements incorporated over time, the overall 5-year survival rate is ~65%. Considerable Stage I perioperative and interstage morbidity and mortality remain, despite refinements of the surgical technique of the Norwood procedure. Two options used to circumvent the birth defect are the Blalock-Taussig (BT) shunt, which connects the right subclavian artery to pulmonary artery, and the Sano shunt, which connects directly from the right ventricle to the pulmonary artery. Although many centers have adopted the Sano shunt because it solves some of the weaknesses of the BT shunt physiology and improves survival outcomes, it has several shortcomings.

David Kalfa, MD, PhD, and associates at Columbia University Medical Center hypothesized that use of the Valved Sano (VS) during the Norwood Stage I operation would improve cardiac hemodynamics, stabilize end-organ function postoperatively, reduce cardiac events and reinterventions, and boost ventricular recovery during the initial Stage I hospitalization and interstage periods. The group reviewed 25 consecutive HLHS neonates who underwent a valved Sano (VS) Stage I operation using a femoral venous homograft and 25 consecutive HLHS neonates who underwent a standard non-valved Sano (NVS) between 2014 and 2022. Primary outcomes were ventricular function, tricuspid regurgitation, end-organ function, Sano and pulmonary artery (PA) reintervention, and survival at post-operative, discharge, interstage, and pre-Glenn time points. 

This retrospective analysis indicates that the VS was associated with improved multi-organ recovery and hemodynamic stability resulting in fewer patients experiencing cardiac events, fewer PA reinterventions before Stage II, and enhanced ventricular function recovery during initial hospitalization following the Norwood operation. These beneficial associations exist without an accompanied increase in conduit reinterventions. These promising findings warrant increased use and study of the VS during the Norwood operation.

Dr. Kalfa will present this study Saturday, May 6, at the American Association for Thoracic Surgery (AATS) 103rd Annual Meeting in Los Angeles.

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The American Association for Thoracic Surgery (AATS) is an international organization that encourages, promotes, and stimulates the scientific investigation of cardiothoracic surgery. Founded in 1917 by a respected group of the earliest pioneers in the field, its original mission was to “foster the evolution of an interest in surgery of the Thorax.” Today, the AATS is the premier association for cardiothoracic surgeons in the world and works to continually enhance the ability of cardiothoracic surgeons to provide the highest quality of patient care. Its more than 1,500 members have a proven record of distinction within the specialty and have made significant contributions to the care and treatment of cardiothoracic disease. Visit aats.org to learn more.