{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,27]],"date-time":"2026-10-27T16:05:48Z","timestamp":1793117148465,"version":"4.5.0"},"reference-count":24,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"21","content-domain":{"domain":["www.ahajournals.org"],"crossmark-restriction":true},"short-container-title":["Circulation"],"published-print":{"date-parts":[[2018,5,22]]},"abstract":"<jats:sec>\n            <jats:title>Background:<\/jats:title>\n            <jats:p>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\u2013Taussig shunt in patients with hypoplastic left heart and related syndromes. At 6 years, we compared transplant-free survival and other outcomes between the groups.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Methods:<\/jats:title>\n            <jats:p>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.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Results:<\/jats:title>\n            <jats:p>\n              Transplant-free survival for the RVPAS versus modified Blalock\u2013Taussig shunt groups did not differ at 6 years (64% versus 59%,\n              <jats:italic>P<\/jats:italic>\n              =0.25) or with all available follow-up of 7.1\u00b11.6 years (log-rank\n              <jats:italic>P<\/jats:italic>\n              =0.13). The RVPAS versus modified Blalock\u2013Taussig shunt treatment effect had nonproportional hazards (\n              <jats:italic>P<\/jats:italic>\n              =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\u20130.92). 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\u20132.17;\n              <jats:italic>P<\/jats:italic>\n              =0.17) or after the Fontan procedure (HR, 0.76; 95% confidence interval, 0.33\u20131.74;\n              <jats:italic>P<\/jats:italic>\n              =0.52). By 6 years, patients with RVPAS had a higher incidence of catheter interventions (0.38 versus 0.23\/patient-year,\n              <jats:italic>P<\/jats:italic>\n              &lt;0.001), primarily because of more interventions between the stage II and Fontan procedures (HR, 1.72; 95% confidence interval, 1.00\u20133.03). 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.\n            <\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Conclusions:<\/jats:title>\n            <jats:p>By 6 years, the hazards of death or transplant and catheter interventions were not different between the RVPAS versus modified Blalock\u2013Taussig 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.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Clinical Trial Registration:<\/jats:title>\n            <jats:p>\n              URL:\n              <jats:ext-link xmlns:xlink=\"http:\/\/www.w3.org\/1999\/xlink\" ext-link-type=\"uri\" xlink:href=\"https:\/\/www.clinicaltrials.gov\">https:\/\/www.clinicaltrials.gov<\/jats:ext-link>\n              . Unique identifier: NCT00115934.\n            <\/jats:p>\n          <\/jats:sec>","DOI":"10.1161\/circulationaha.117.029375","type":"journal-article","created":{"date-parts":[[2018,2,1]],"date-time":"2018-02-01T10:25:17Z","timestamp":1517480717000},"page":"2246-2253","update-policy":"https:\/\/doi.org\/10.1161\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":249,"title":["Transplant-Free Survival and Interventions at 6 Years in the SVR Trial"],"prefix":"10.1161","volume":"137","author":[{"given":"Jane W.","family":"Newburger","sequence":"first","affiliation":[{"name":"Boston Children\u2019s Hospital and Harvard Medical School, MA (J.W.N., L.A.S., C.D.-M.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lynn A.","family":"Sleeper","sequence":"additional","affiliation":[{"name":"Boston Children\u2019s Hospital and Harvard Medical School, MA (J.W.N., L.A.S., C.D.-M.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"J. William","family":"Gaynor","sequence":"additional","affiliation":[{"name":"Children\u2019s Hospital of Philadelphia and University of Pennsylvania Medical School, Philadelphia (J.W.G.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Danielle","family":"Hollenbeck-Pringle","sequence":"additional","affiliation":[{"name":"New England Research Institutes, Watertown, MA (D.H.-P., S.C., P.S.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Peter C.","family":"Frommelt","sequence":"additional","affiliation":[{"name":"Children\u2019s Hospital of Wisconsin and Medical College of Wisconsin, Milwaukee (P.C.F., N.S.G.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jennifer S.","family":"Li","sequence":"additional","affiliation":[{"name":"North Carolina Consortium, Duke University, Durham (J.S.L.)."},{"name":"East Carolina University, Greenville, NC (J.S.L.)."},{"name":"Wake Forest University, Winston-Salem, NC (J.S.L.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"William T.","family":"Mahle","sequence":"additional","affiliation":[{"name":"Children\u2019s Healthcare of Atlanta and Emory University, GA (W.T.M.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ismee A.","family":"Williams","sequence":"additional","affiliation":[{"name":"Morgan Stanley Children\u2019s Hospital of New York-Presbyterian, Columbia College of Physicians and Surgeons, NY (I.A.W.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Andrew M.","family":"Atz","sequence":"additional","affiliation":[{"name":"Medical University of South Carolina, Charleston (A.M.A.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kristin M.","family":"Burns","sequence":"additional","affiliation":[{"name":"National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD (KM.B.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shan","family":"Chen","sequence":"additional","affiliation":[{"name":"New England Research Institutes, Watertown, MA (D.H.-P., S.C., P.S.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"James","family":"Cnota","sequence":"additional","affiliation":[{"name":"Cincinnati Children\u2019s Medical Center, OH (J.C.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Carolyn","family":"Dunbar-Masterson","sequence":"additional","affiliation":[{"name":"Boston Children\u2019s Hospital and Harvard Medical School, MA (J.W.N., L.A.S., C.D.-M.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nancy S.","family":"Ghanayem","sequence":"additional","affiliation":[{"name":"Children\u2019s Hospital of Wisconsin and Medical College of Wisconsin, Milwaukee (P.C.F., N.S.G.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Caren S.","family":"Goldberg","sequence":"additional","affiliation":[{"name":"University of Michigan Medical School, Ann Arbor (C.S.G., R.G.O.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jeffrey P.","family":"Jacobs","sequence":"additional","affiliation":[{"name":"Congenital Heart Institute of Florida, St. Petersburg (J.P.J.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alan B.","family":"Lewis","sequence":"additional","affiliation":[{"name":"Children\u2019s Hospital Los Angeles, CA (A.B.L.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Seema","family":"Mital","sequence":"additional","affiliation":[{"name":"Hospital for Sick Children, Toronto, Ontario, Canada (S.M.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Christian","family":"Pizarro","sequence":"additional","affiliation":[{"name":"Nemours Cardiac Center, Wilmington, DE 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