Which HLHS surgery works better?

Update: My friend is out of surgery and doing well!

The three operation Norwood Procedure was developed in the 1980’s as an answer to Hypoplastic Left Heart Syndrome (HLHS). Since infant heart transplant was developed at about the same time, HLHS was 100% fatal before the invention of the Norwood.

But the results from those early Norwood Procedures varied wildly, especially in the early days when the Norwood consisted of only two surgeries. When the Sano Shunt – a direct Right Ventricle to Pulmonary Artery connection, using a “tube” made of Goretex – was introduced in early 2003, matters improved greatly. The Sano Shunt provided the heart with much more stability and increased survivability rates.

But while we know that the Sano works better, there hasn’t been much research into how much better it works…. until now.

The Pediatric Heart Network studied the cases of 555 infants with HLHS. Through random selection, roughly half of the infants received the Stage I Norwood with a Sano Shunt, the other half received the Stage I Norwood with a Modified Blalock-Taussig Shunt (MBTS).

Followup with the children showed that 26% of the Sano Shunt children required a heart transplant before the age of 1; 36% of the children with the MBTS version needed a transplant. But after two years, the number of children who needed a heart transplant was within four percentage points of each other. Good Pulmonary Artery growth helps in the success of Stage II and Stage III of the Norwood, and the MBTS seems to encourage Pulmonary Artery growth.

Meanwhile, the Sano Shunt had more complications that required a balloon or a stent to keep the shunt open. True, this is not as serious procedure as open heart surgery, but the fewer, the better. After all, minor surgery is any surgery that happens to someone I don’t know – when it is YOU, your child, or a family member, things quickly become very serious!

Overall, it seems that the Sano Shunt gives an HLHS patient better results over the first two years – after that, the odds even out. These children will have to be followed for years to determine the long term success rate of either the Sano Shunt or the Modified Blalock-Taussig.

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5 Responses to “Which HLHS surgery works better?”

  1. Cindy Says:

    Hi! I am fairly new to your blog. I found it because someone recommended it in our heart newsletter in the city I live (Calgary Canada). Thanks for all of your info! I have a couple of things to say. Thanks very much for your recommendation of the book Walk on Water. I ordered it the same day you posted about it. When it arrived I sat and stared at it for a couple of days. Finally I picked it up and read it. I cried nonstop through the first chapter. Then toughened up and only cried a few more times though the book. I thoroughly enjoyed it! I was also shocked to learn that in 2008 Dr Johnathan Drummond-Webb took his own life. Very sad.
    Anyway, going to today’s blog, my two year old daughter Alexa has critical aortic stenosis. They tried twice to open her aorta but it just wouldn’t open. Her mitral valve is also deformed and her left ventricle wasn’t pumping strong enough. So when she was one month old she had the Norwood and at 5 months the Glenn. She has a sano shunt. I know that traditionally surgeons close the shunt during the Glenn but her surgeon wanted to try something different and left it open. Have you ever heard of this? She is doing great now but her cardiologist says it is hard to say whether or not it is from the open shunt. Also, they have been expecting her lv to stop growing but it has continued to grow and is pushing a bit on the rv so they keep postponing the Fontan. I am wondering if this has anything to do with the shunt remaining open? I would appreciate any knowledge on this that you can share with me!
    Take care and keep posting!
    Cindy

    • Steve Says:

      Hi, Cindy!

      I really don’t know about leaving the Sano open or not – I have not seen any research on it (which doesn’t mean that there isn’t any, of course) but I just can’t say.

      What do the doctors think about Alexa’s Ventricles pushing on each other? If it is having a positive effect, that’s wonderful; but make sure that delaying the operation won’t make things more difficult when/if it is time to finally operate. Your Cardiologists have probably considered that, ask him/her what they think.

      Do you take Alexa to Sick Kids in Toronto? (if I am in the wrong Provence, forgive me, my knowledge of Canadian Geography isn’t the best) When I was at Johns Hopkins for my first surgery, my cardiologist was Dr. Richard Rowe. He left Hopkins a few years after that and started the heart program at Sick Kids.

  2. Tweets that mention Which HLHS surgery works better? « Adventures of a Funky Heart! -- Topsy.com Says:

    […] This post was mentioned on Twitter by Steve, Steve. Steve said: NEW on the Funky Heart blog: 2 HLHS surgical options compared. http://tinyurl.com/yj4m72l #CHD #HLHS Please Retweet! […]

  3. Anonymous Says:

    Hi my name is Helen my baby is a hlhs and sometimes i woory if someone can tell me how is the after affect after the first stage i will appriciate, my baby is 4 month now

  4. helen Says:

    hi hobe your baby is doing good

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