Newer Heart Surgery for Infants Offers First-Year Survival Benefit over Traditional Procedure
Infants born with a severely underdeveloped heart who undergo a newer surgical procedure are more likely to survive their first year and not require a heart transplant than those who have a more traditional surgical procedure, according to a report by researchers supported by the National Heart, Lung, and Blood Institute (NHLBI). The study is the largest comparative effectiveness study for congenital heart disease and the first North American multi-center randomized trial of congenital heart disease.
Akinso: Infants born with a severely underdeveloped heart who undergo a newer surgical procedure are more likely to survive their first year and not require a heart transplant. This is according to a report by researchers supported by the National Heart, Lung, and Blood Institute. But the study of 549 newborns suggests that after the first year, the new surgical procedure yields similar results to a more traditional one.
Pearson: This study enrolled newborns who are born with only one functioning pumping chamber of their heart which is called a ventricle.
Akinso: Dr. Gail Pearson is the director of the NHLBI’s Adult and Pediatric Cardiac Research Program.
Pearson: Most of us are born with two functioning ventricles and these infants have a special type of complex heart disease in which they only have one ventricle— this is called hypoplastic left syndrome. So we were targeting enrolling these babies in order to compare two different types of surgical procedures. For the first procedure that they have to help them in their first couple of weeks of life.
Akinso: The Single Ventricle Reconstruction Trial is the largest trial to compare treatment for congenital heart disease, and the first North American, multi-center, randomized trial of surgical therapy for congenital heart disease patients. Dr. Pearson says two procedures were studied.
Pearson: Both procedures were being used to some extent, but surgeons realized that there were pluses and minuses to both of them. And also realized that they wanted to apply some scientific method to this and figure out which surgical procedure might be better.
Akinso: Congenital heart disease is the most common birth defect. Every year, about 1 percent of babies are born with abnormally formed hearts. The trial compared for the first time two surgical procedures that are commonly used to treat babies born with only the right ventricle, which pumps blood to the lung, to determine whether one procedure improves outcomes more than the other. Dr. Pearson explains the two procedures.
Pearson: The more standard one involves the use of what's called a modified Blalock-Taussig shunt and this is one means of getting blood to flow to the baby's lungs in order to provide oxygenated blood to be pumped to the body. The newer variation, instead of having a shunt from the aorta to the pulmonary artery, which is what the modified Blacklock-Taussig shunt is, has a shunt for the blood directly from the right ventricle, which is the baby’s only functioning ventricle to the pulmonary artery.
Akinso: Researchers followed all study patients for at least 14 months. They evaluated the number of deaths and heart transplantations in each group at one year, as well as the number of complications.
Pearson: The overall conclusion was that for the first year of life the newer procedure offers improved survival without needing a heart transplant.
Akinso: Dr. Pearson adds that this study shows great promise for helping not only this high-risk group of patients, but also for improving the health and well being of many more babies and children with heart problems. For more information on this study, visit nhlbi.nih.gov. This is Wally Akinso at the National Institutes of Health Bethesda, Maryland.
About This Audio Report
Reporter: Wally Akinso
Sound Bite: Dr. Gail Pearson
Topic: Congenital Heart Disease, infants, surgical procedures