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Transplant-Free Survival and Interventions at 6 Years in the SVR Trial. Circulation 2018 05 22;137(21):2246-2253

Date

02/14/2018

Pubmed ID

29437119

Pubmed Central ID

PMC5963989

DOI

10.1161/CIRCULATIONAHA.117.029375

Scopus ID

2-s2.0-85053530349   22 Citations

Abstract

BACKGROUND: In the SVR trial (Single Ventricle Reconstruction), 1-year transplant-free survival was better for the Norwood procedure with right ventricle-to-pulmonary artery shunt (RVPAS) compared with a modified Blalock-Taussig shunt in patients with hypoplastic left heart and related syndromes. At 6 years, we compared transplant-free survival and other outcomes between the groups.

METHODS: Medical history was collected annually using medical record review, telephone interviews, and the death index. The cohort included 549 patients randomized and treated in the SVR trial.

RESULTS: Transplant-free survival for the RVPAS versus modified Blalock-Taussig shunt groups did not differ at 6 years (64% versus 59%, =0.25) or with all available follow-up of 7.1±1.6 years (log-rank =0.13). The RVPAS versus modified Blalock-Taussig shunt treatment effect had nonproportional hazards (=0.009); the hazard ratio (HR) for death or transplant favored the RVPAS before stage II surgery (HR, 0.66; 95% confidence interval, 0.48-0.92). The effect of shunt type on death or transplant was not statistically significant between stage II to Fontan surgery (HR, 1.36; 95% confidence interval, 0.86-2.17; =0.17) or after the Fontan procedure (HR, 0.76; 95% confidence interval, 0.33-1.74; =0.52). By 6 years, patients with RVPAS had a higher incidence of catheter interventions (0.38 versus 0.23/patient-year, <0.001), primarily because of more interventions between the stage II and Fontan procedures (HR, 1.72; 95% confidence interval, 1.00-3.03). Complications did not differ by shunt type; by 6 years, 1 in 5 patients had had a thrombotic event, and 1 in 6 had had seizures.

CONCLUSIONS: By 6 years, the hazards of death or transplant and catheter interventions were not different between the RVPAS versus modified Blalock-Taussig shunt groups. Children assigned to the RVPAS group had 5% higher transplant-free survival, but the difference did not reach statistical significance, and they required more catheter interventions. Both treatment groups have accrued important complications.

CLINICAL TRIAL REGISTRATION: URL: https://www.clinicaltrials.gov. Unique identifier: NCT00115934.

Author List

Newburger JW, Sleeper LA, Gaynor JW, Hollenbeck-Pringle D, Frommelt PC, Li JS, Mahle WT, Williams IA, Atz AM, Burns KM, Chen S, Cnota J, Dunbar-Masterson C, Ghanayem NS, Goldberg CS, Jacobs JP, Lewis AB, Mital S, Pizarro C, Eckhauser A, Stark P, Ohye RG, Pediatric Heart Network Investigators

Author

Peter C. Frommelt MD Professor in the Pediatrics department at Medical College of Wisconsin




MESH terms used to index this publication - Major topics in bold

Blalock-Taussig Procedure
Cardiac Catheterization
Child, Preschool
Disease-Free Survival
Follow-Up Studies
Fontan Procedure
Heart Transplantation
Heart Ventricles
Humans
Hypoplastic Left Heart Syndrome
Infant
Interviews as Topic
Kaplan-Meier Estimate
Norwood Procedures
Proportional Hazards Models
Pulmonary Artery
Seizures
Thrombosis
jenkins-FCD Prod-399 190a069c593fb5498b7fcd942f44b7bc9cdc7ea1