Authors: Awori N Mark, Awori A Jonathan, Ibrahim M Hassan, Kipkoech Kimberly.
Objectives: Palliative surgery has improved the long-term survival of patients with Double inlet left ventricle (DILV). Neonates and infants with DILV presenting with reduced pulmonary blood flow (RPBF) are often offered a systemic arterial-to- pulmonary artery shunt (SAPAS). There is evidence that SAPAS in these patients, may not improve survival compared to the natural history. An objective assessment of the efficacy of a treatment requires a comparison of the treatment outcome with the natural history. Our aim was to review the literature to determine whether SAPASs in patients with DILV and RPBF improves survival compare to the natural history.
Methods: We reviewed the literature and used the most externally valid data to create a composite survival curve that facilitates the comparison of surgical outcome and natural history.
Results: The data suggests that SAPASs in patient with DILV and RBPF, may not improve long term survival compared to the natural history. There is also evidence that palliative surgery in general in patients older than 1 year of age with increased or balanced pulmonary blood flow may not improve survival compared to the natural history.
Conclusions: SAPASs probably should not be offered to patients with DILV and RPBF. In addition, cardiac surgery probably should not be offered to patients with DILV presenting for the first time after 1 year of age.
View/Download pdf