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Wang AP, Husain N, Penk J, Laternser C, Magnetta D, Watanabe K, Hauck A. Prognostic Value of RV Function Analysis During the Interstage Period in Patients with Hypoplastic Left Heart Syndrome. Pediatr Cardiol 2024; 45:1120-1128. [PMID: 38519623 DOI: 10.1007/s00246-024-03463-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/10/2023] [Accepted: 02/26/2024] [Indexed: 03/25/2024]
Abstract
Cardiac dysfunction is associated with mortality in children with hypoplastic left heart syndrome (HLHS). We evaluated the ability of qualitative and quantitative RV functional parameters to predict outcomes in HLHS patients. In this retrospective, single-center study, echocardiograms from 3 timepoints (pre-stage 1 palliation, 4-8 weeks post-stage 1 palliation, and pre-Glenn) were analyzed in infants with HLHS. Patients were stratified into two groups based on outcome of transplant-free survival post-Glenn (survivors) versus mortality or transplantation prior to Fontan (non-survivors). Images were retrospectively reviewed to obtain RV global longitudinal strain (RVGLS), RV-free wall strain (RVFWS), fractional area change (FAC), tricuspid annular systolic plane excursion (TAPSE), tissue motion annular displacement of the tricuspid valve (TMAD-TV) and qualitative systolic function assessment during the predetermined timepoints. An equal variance t-test and chi-square were used to determine significant differences and ROC curve analysis was performed to derive optimal cutoff values to predict mortality/transplant. A total of 47 patients met inclusion criteria, of which, 21 patients met composite endpoint. There were no significant differences in any RV functional parameter during the pre- or post-stage 1 palliation timepoints. The absolute values of RVFWS, RVGLS, and TMAD-TV were significantly greater in survivors than non-survivors during the pre-Glenn timepoint. A pre-Glenn RVGLS > -15.6 (AUC 0.79), RVFWS > -18.6 (AUC 0.75), and TMAD-TV < 12.6% (AUC 0.82) were sensitive and specific for predicting death or need for transplantation prior to Fontan completion. RVGLS, RVFWS, and TMAD-TV may help identify higher-risk HLHS patients during the interstage period.
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Affiliation(s)
- Alan P Wang
- Division of Pediatric Cardiology, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, USA.
| | - Nazia Husain
- Division of Pediatric Cardiology, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, USA
| | - Jamie Penk
- Division of Pediatric Cardiology, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, USA
| | - Christina Laternser
- Division of Pediatric Cardiology, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, USA
| | - Defne Magnetta
- Division of Pediatric Cardiology, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, USA
| | - Kae Watanabe
- Lillie Frank Abercrombie Division of Pediatric Cardiology, Department of Pediatrics, Texas Children's Hospital, Baylor College of Medicine, Houston, TX, USA
| | - Amanda Hauck
- Division of Pediatric Cardiology, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, USA
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Jacquemyn X, Singh TP, Gossett JG, Averin K, Kutty S, Zühlke LJ, Abdullahi LH, Kulkarni A. Mortality and Heart Transplantation After Hybrid Palliation of Hypoplastic Left Heart Syndrome: A Systematic Review and Meta-Analysis. World J Pediatr Congenit Heart Surg 2024; 15:215-223. [PMID: 38404131 DOI: 10.1177/21501351231224323] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/27/2024]
Abstract
BACKGROUND Newborns with hypoplastic left heart syndrome (HLHS) who are considered at increased risk for death following Norwood/Sano surgery often undergo hybrid palliation (HP) as initial surgery. We aimed to compile the HP experience in HLHS and its variants and assess the rates of, and risk factors for, death and heart transplantation. METHODS CINAHL, CINAHL PLUS, PubMed/MEDLINE, and SCOPUS were systematically searched for HP outcome studies of death or heart transplantation in HLHS between 1998 and 2022. Pooled incidence was estimated, and potential risk factors were identified using random-effects meta-analysis and reconstructed time-to-event data from Kaplan-Meier curves. RESULTS Thirty-three publications were included in our review. Overall, of 1,162 patients 417 died and 57 underwent heart transplantation, resulting in a combined outcome of 40.7%, (474/1,162). There was a trend toward decreasing mortality risk across the stages of palliation. Pooled mortality between HP and comprehensive stage 2 palliation was 25%, after stage 2 up to Fontan palliation was 16%, and 6% post-Fontan. The incidence of death or heart transplantation was higher in high-risk patients-43% died and 10% received heart transplantation. CONCLUSION Our systematic review and meta-analysis found high rates of death or heart transplantation in HP of HLHS patients between HP and Fontan surgeries. All patients should be closely followed during the initial interstage period, which is associated with the highest hazard. Prospective studies on appropriate patient selection, indications, and / or alternatives, as well as refining HP strategies for managing newborns with HLHS are needed to improve outcomes.
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Affiliation(s)
- Xander Jacquemyn
- Helen B. Taussig Heart Center, Department of Pediatrics, Johns Hopkins Hospital, Baltimore, MD, USA
- Department of Cardiovascular Sciences, KU Leuven, Leuven, Belgium
| | - Tajinder P Singh
- Department of Cardiology, Boston Children's Hospital, Boston, MA, USA
| | - Jeffrey G Gossett
- Cohen Children's Heart Center, Donald and Barbara Zucker School of Medicine at Hofstra/ Northwell, New Hyde Park, NY, USA
| | - Konstantin Averin
- Cohen Children's Heart Center, Donald and Barbara Zucker School of Medicine at Hofstra/ Northwell, New Hyde Park, NY, USA
| | - Shelby Kutty
- Helen B. Taussig Heart Center, Department of Pediatrics, Johns Hopkins Hospital, Baltimore, MD, USA
| | - Liesl J Zühlke
- President's Office, South African Medical Research Council, Cape Town, South Africa
- Division of Paediatric Cardiology, Department of Paediatrics, Institute of Child Health, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
| | - Leila H Abdullahi
- Save the Children International (SCI), Somalia/Somaliland Country Office. Nairobi, Kenya
| | - Aparna Kulkarni
- Cohen Children's Heart Center, Donald and Barbara Zucker School of Medicine at Hofstra/ Northwell, New Hyde Park, NY, USA
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Carvajal HG, Canter MW, Wan F, Eghtesady P. Hypoplastic Left Heart Syndrome With Low Birth Weight or Prematurity: What Is the Optimal Approach? Ann Thorac Surg 2023; 116:988-995. [PMID: 37429513 DOI: 10.1016/j.athoracsur.2023.06.025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/06/2022] [Revised: 05/08/2023] [Accepted: 06/20/2023] [Indexed: 07/12/2023]
Abstract
BACKGROUND Hypoplastic left heart syndrome with low birth weight or prematurity comprises a high-risk population with no optimal treatment pathway. Using the Pediatric Health Information System, we compared management approaches across the United States. METHODS We analyzed neonates (≤30 days) with birth weight <2500 grams or gestational age <36 weeks between 2012 and 2021. Four strategies were identified: Norwood procedure, ductus arteriosus stent + pulmonary artery banding, pulmonary artery banding + prostaglandin infusion, or comfort care. Outcomes included hospital survival, discharge disposition, staged palliation completion, and 1-year transplant-free survival. RESULTS Of 383 infants identified, 36.4% (n = 134) received comfort care, 43.9% (n = 165) Norwood, 12.4% (n = 49) ductal stent + pulmonary artery bands, and 8.8% (n = 34) pulmonary artery bands + prostaglandins. Neonates receiving comfort care had the lowest gestational age (35 weeks; interquartile range [IQR], 31.5-37 weeks) and birth weight (2.0 kg; IQR, 1.5-2.3 kg); 24.6% (33 of 134) had chromosomal anomalies. Infants undergoing primary Norwood had the highest birth weight (2.4 kg; IQR, 2.2-2.5 kg) and gestational age (37 weeks; IQR, 35-38 weeks). Glenn palliation was performed in 66.1% (109 of 165) compared with ductal stent + pulmonary artery band in 18.4% (9 of 49) and pulmonary artery band + prostaglandins in 35.3% (12 of 34). Only 11.3% (6 of 53) born <2 kg survived to 1 year, all after Norwood. Primary Norwood yielded higher hospital and 1-year transplant-free survival than hybrid strategies. CONCLUSIONS Comfort care is routinely provided, particularly for infants with low birth weight, gestational age, or chromosomal anomalies. Primary Norwood offered the lowest hospital and 1-year mortality and highest palliation completion rates; birth weight was the most important factor determining 1-year survival.
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Affiliation(s)
- Horacio G Carvajal
- Section of Pediatric Cardiothoracic Surgery, Washington University School of Medicine in St. Louis, St Louis, Missouri
| | - Matthew W Canter
- Section of Pediatric Cardiothoracic Surgery, Washington University School of Medicine in St. Louis, St Louis, Missouri
| | - Fei Wan
- Section of Pediatric Cardiothoracic Surgery, Washington University School of Medicine in St. Louis, St Louis, Missouri
| | - Pirooz Eghtesady
- Section of Pediatric Cardiothoracic Surgery, Washington University School of Medicine in St. Louis, St Louis, Missouri.
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Birla AK, Brimmer S, Short WD, Olutoye OO, Shar JA, Lalwani S, Sucosky P, Parthiban A, Keswani SG, Caldarone CA, Birla RK. Current state of the art in hypoplastic left heart syndrome. Front Cardiovasc Med 2022; 9:878266. [PMID: 36386362 PMCID: PMC9651920 DOI: 10.3389/fcvm.2022.878266] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2022] [Accepted: 08/30/2022] [Indexed: 11/29/2022] Open
Abstract
Hypoplastic left heart syndrome (HLHS) is a complex congenital heart condition in which a neonate is born with an underdeveloped left ventricle and associated structures. Without palliative interventions, HLHS is fatal. Treatment typically includes medical management at the time of birth to maintain patency of the ductus arteriosus, followed by three palliative procedures: most commonly the Norwood procedure, bidirectional cavopulmonary shunt, and Fontan procedures. With recent advances in surgical management of HLHS patients, high survival rates are now obtained at tertiary treatment centers, though adverse neurodevelopmental outcomes remain a clinical challenge. While surgical management remains the standard of care for HLHS patients, innovative treatment strategies continue to be developing. Important for the development of new strategies for HLHS patients is an understanding of the genetic basis of this condition. Another investigational strategy being developed for HLHS patients is the injection of stem cells within the myocardium of the right ventricle. Recent innovations in tissue engineering and regenerative medicine promise to provide important tools to both understand the underlying basis of HLHS as well as provide new therapeutic strategies. In this review article, we provide an overview of HLHS, starting with a historical description and progressing through a discussion of the genetics, surgical management, post-surgical outcomes, stem cell therapy, hemodynamics and tissue engineering approaches.
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Affiliation(s)
- Aditya K. Birla
- Laboratory for Regenerative Tissue Repair, Texas Children's Hospital, Houston, TX, United States
- Center for Congenital Cardiac Research, Texas Children's Hospital, Houston, TX, United States
| | - Sunita Brimmer
- Laboratory for Regenerative Tissue Repair, Texas Children's Hospital, Houston, TX, United States
- Center for Congenital Cardiac Research, Texas Children's Hospital, Houston, TX, United States
- Division of Congenital Heart Surgery, Texas Children's Hospital, Houston, TX, United States
| | - Walker D. Short
- Laboratory for Regenerative Tissue Repair, Texas Children's Hospital, Houston, TX, United States
- Department of Surgery, Baylor College of Medicine, Houston, TX, United States
- Division of Pediatric Surgery, Department of Surgery, Texas Children's Hospital, Houston, TX, United States
| | - Oluyinka O. Olutoye
- Laboratory for Regenerative Tissue Repair, Texas Children's Hospital, Houston, TX, United States
- Department of Surgery, Baylor College of Medicine, Houston, TX, United States
- Division of Pediatric Surgery, Department of Surgery, Texas Children's Hospital, Houston, TX, United States
| | - Jason A. Shar
- Department of Mechanical Engineering, Kennesaw State University, Marietta, GA, United States
| | - Suriya Lalwani
- Laboratory for Regenerative Tissue Repair, Texas Children's Hospital, Houston, TX, United States
- Center for Congenital Cardiac Research, Texas Children's Hospital, Houston, TX, United States
| | - Philippe Sucosky
- Department of Mechanical Engineering, Kennesaw State University, Marietta, GA, United States
| | - Anitha Parthiban
- Department of Surgery, Baylor College of Medicine, Houston, TX, United States
- Division of Pediatric Surgery, Department of Surgery, Texas Children's Hospital, Houston, TX, United States
- Division of Pediatric Cardiology, Texas Children's Hospital, Houston, TX, United States
| | - Sundeep G. Keswani
- Laboratory for Regenerative Tissue Repair, Texas Children's Hospital, Houston, TX, United States
- Center for Congenital Cardiac Research, Texas Children's Hospital, Houston, TX, United States
- Department of Surgery, Baylor College of Medicine, Houston, TX, United States
- Division of Pediatric Surgery, Department of Surgery, Texas Children's Hospital, Houston, TX, United States
| | - Christopher A. Caldarone
- Center for Congenital Cardiac Research, Texas Children's Hospital, Houston, TX, United States
- Division of Congenital Heart Surgery, Texas Children's Hospital, Houston, TX, United States
- Department of Surgery, Baylor College of Medicine, Houston, TX, United States
- Division of Pediatric Surgery, Department of Surgery, Texas Children's Hospital, Houston, TX, United States
| | - Ravi K. Birla
- Laboratory for Regenerative Tissue Repair, Texas Children's Hospital, Houston, TX, United States
- Center for Congenital Cardiac Research, Texas Children's Hospital, Houston, TX, United States
- Division of Congenital Heart Surgery, Texas Children's Hospital, Houston, TX, United States
- Department of Surgery, Baylor College of Medicine, Houston, TX, United States
- Division of Pediatric Surgery, Department of Surgery, Texas Children's Hospital, Houston, TX, United States
- *Correspondence: Ravi K. Birla
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Congenital heart disease: pathology, natural history, and interventions. Cardiovasc Pathol 2022. [DOI: 10.1016/b978-0-12-822224-9.00011-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
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6
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Ho AB, Hribernik I, Shillaker D, Thomson J, Salam A, Dedieu N, Giardini A, Derrick G, O'Callaghan B, Gibb J, Gonzalez-Barlatay F, Taliotis D, Johns M, Hayes N, Bentham JR. Hybrid Palliation for Hypoplastic Left Heart Syndrome: Association With Contemporary Outcomes. Circulation 2021; 144:1189-1191. [PMID: 34606304 DOI: 10.1161/circulationaha.121.055183] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Andrew B Ho
- Paediatric Cardiology, Southampton General Hospital, United Kingdom (A.B.H., M.J., N.H.).,Department of Congenital Cardiology, Leeds General Infirmary, United Kingdom (A.B.H., I.H., J.T., J.R.B.)
| | - Ines Hribernik
- Department of Congenital Cardiology, Leeds General Infirmary, United Kingdom (A.B.H., I.H., J.T., J.R.B.)
| | | | - John Thomson
- Department of Congenital Cardiology, Leeds General Infirmary, United Kingdom (A.B.H., I.H., J.T., J.R.B.)
| | - Abdul Salam
- Paediatric Cardiology, Great Ormond Street Hospital, London, United Kingdom (A.S., N.D., A.G., G.D.)
| | - Nathalie Dedieu
- Paediatric Cardiology, Great Ormond Street Hospital, London, United Kingdom (A.S., N.D., A.G., G.D.)
| | - Alessandro Giardini
- Paediatric Cardiology, Great Ormond Street Hospital, London, United Kingdom (A.S., N.D., A.G., G.D.)
| | - Graham Derrick
- Paediatric Cardiology, Great Ormond Street Hospital, London, United Kingdom (A.S., N.D., A.G., G.D.)
| | - Barry O'Callaghan
- Paediatric Cardiology, Bristol Royal Hospital for Children, United Kingdom (B.O'C., J.G., F.G.-B., D.T.)
| | - Jack Gibb
- Paediatric Cardiology, Bristol Royal Hospital for Children, United Kingdom (B.O'C., J.G., F.G.-B., D.T.)
| | | | - Demitris Taliotis
- Paediatric Cardiology, Bristol Royal Hospital for Children, United Kingdom (B.O'C., J.G., F.G.-B., D.T.)
| | - Melonie Johns
- Paediatric Cardiology, Southampton General Hospital, United Kingdom (A.B.H., M.J., N.H.)
| | - Nicholas Hayes
- Paediatric Cardiology, Southampton General Hospital, United Kingdom (A.B.H., M.J., N.H.)
| | - James R Bentham
- Department of Congenital Cardiology, Leeds General Infirmary, United Kingdom (A.B.H., I.H., J.T., J.R.B.)
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Alphonso N, Angelini A, Barron DJ, Bellsham-Revell H, Blom NA, Brown K, Davis D, Duncan D, Fedrigo M, Galletti L, Hehir D, Herberg U, Jacobs JP, Januszewska K, Karl TR, Malec E, Maruszewski B, Montgomerie J, Pizzaro C, Schranz D, Shillingford AJ, Simpson JM. Guidelines for the management of neonates and infants with hypoplastic left heart syndrome: The European Association for Cardio-Thoracic Surgery (EACTS) and the Association for European Paediatric and Congenital Cardiology (AEPC) Hypoplastic Left Heart Syndrome Guidelines Task Force. Eur J Cardiothorac Surg 2020; 58:416-499. [DOI: 10.1093/ejcts/ezaa188] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Affiliation(s)
- Nelson Alphonso
- Queensland Pediatric Cardiac Service, Queensland Children’s Hospital, University of Queensland, Brisbane, QLD, Australia
| | - Annalisa Angelini
- Department of Cardiac, Thoracic Vascular Sciences and Public health, University of Padua Medical School, Padua, Italy
| | - David J Barron
- Department of Cardiovascular Surgery, Hospital for Sick Children, University of Toronto, Toronto, ON, Canada
| | | | - Nico A Blom
- Division of Pediatric Cardiology, Department of Pediatrics, Leiden University Medical Center, Leiden, Netherlands
| | - Katherine Brown
- Paediatric Intensive Care, Heart and Lung Division, Great Ormond Street Hospital NHS Foundation Trust, London, UK
| | - Deborah Davis
- Department of Anesthesiology, Thomas Jefferson University, Philadelphia, PA, USA
- Nemours Cardiac Center, A.I. Du Pont Hospital for Children, Wilmington, DE, USA
| | - Daniel Duncan
- Nemours Cardiac Center, A.I. Du Pont Hospital for Children, Wilmington, DE, USA
| | - Marny Fedrigo
- Department of Cardiac, Thoracic Vascular Sciences and Public Health, University of Padua Medical School, Padua, Italy
| | - Lorenzo Galletti
- Unit of Pediatric Cardiac Surgery, Bambino Gesù Children's Hospital, Rome, Italy
| | - David Hehir
- Division of Cardiology, Children’s Hospital of Philadelphia, Philadelphia, PA, USA
| | - Ulrike Herberg
- Department of Pediatric Cardiology, University Hospital Bonn, Bonn, Germany
| | | | - Katarzyna Januszewska
- Division of Pediatric Cardiac Surgery, University Hospital Muenster, Westphalian-Wilhelm’s-University, Muenster, Germany
| | | | - Edward Malec
- Division of Pediatric Cardiac Surgery, University Hospital Muenster, Westphalian-Wilhelm’s-University, Muenster, Germany
| | - Bohdan Maruszewski
- Department for Pediatric Cardiothoracic Surgery, Children's Memorial Health Institute, Warsaw, Poland
| | - James Montgomerie
- Department of Anesthesia, Birmingham Children’s Hospital, Birmingham, UK
| | - Christian Pizzaro
- Nemours Cardiac Center, A.I. Du Pont Hospital for Children, Wilmington, DE, USA
- Department of Surgery, Thomas Jefferson University, Philadelphia, PA, USA
| | - Dietmar Schranz
- Pediatric Heart Center, Justus-Liebig University, Giessen, Germany
| | - Amanda J Shillingford
- Division of Cardiology, Children's Hospital of Philadelphia, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
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Mohanty SR, Patel A, Kundan S, Radhakrishnan HB, Rao SG. Hypoplastic left heart syndrome: current modalities of treatment and outcomes. Indian J Thorac Cardiovasc Surg 2020; 37:26-35. [PMID: 33584025 DOI: 10.1007/s12055-019-00919-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2019] [Revised: 12/18/2019] [Accepted: 12/22/2019] [Indexed: 11/27/2022] Open
Abstract
Hypoplastic left heart syndrome is a constellation of malformations which result from the severe underdevelopment of any left-sided cardiac structures. Once considered to be universally fatal, the prognosis for this condition has tremendously improved over the past four decades since the work of William Norwood in the early 1980s. Today, a staged surgical approach is applied for palliating this distinctive cohort of patients, in which they undergo three operative procedures in the first 10 years of their life. Advancements in medical technologies, surgical techniques, and our growing experience in the management of HLHS have made survival into adulthood a possibility. Through this review, we present the different phases of the staged approach with primary focus on stage 1-its modifications, current technique, alternatives, and latest outcomes.
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Affiliation(s)
- Smruti Ranjan Mohanty
- Department of Pediatric and Congenital Heart Surgery, Kokilaben Dhirubhai Ambani Hospital, Four Bungalows, Andheri (West), Mumbai, 400053 India
| | | | - Simran Kundan
- Department of Pediatric and Congenital Heart Surgery, Kokilaben Dhirubhai Ambani Hospital, Four Bungalows, Andheri (West), Mumbai, 400053 India
| | - Hari Bipin Radhakrishnan
- Department of Pediatric and Congenital Heart Surgery, Kokilaben Dhirubhai Ambani Hospital, Four Bungalows, Andheri (West), Mumbai, 400053 India
| | - Suresh Gururaja Rao
- Department of Pediatric and Congenital Heart Surgery, Kokilaben Dhirubhai Ambani Hospital, Four Bungalows, Andheri (West), Mumbai, 400053 India
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Early and Midterm Outcomes in High-risk Single-ventricle Patients: Hybrid Vs Norwood Palliation. Ann Thorac Surg 2019; 108:1849-1855. [PMID: 31404546 DOI: 10.1016/j.athoracsur.2019.06.061] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2019] [Revised: 06/05/2019] [Accepted: 06/17/2019] [Indexed: 10/26/2022]
Abstract
BACKGROUND Although overall outcomes have improved for single-ventricle patients, substantial morbidity and mortality remain for certain high-risk groups. The hybrid stage I procedure is an alternative to the Norwood operation for stage I palliation, but it remains unclear whether it is associated with improved outcomes in high-risk patients. METHODS This single-center, nested, case-control study included high-risk patients with a systemic right ventricle who underwent hybrid stage I or Norwood palliation from January 2000 to December 2016. High-risk features included prematurity < 34 weeks, birth weight < 2.5 kg, restrictive/intact atrial septum, at least moderate atrioventricular valve regurgitation or right ventricular dysfunction, genetic or extracardiac anomalies, or left ventricular sinusoids. Patients were matched by presence of genetic anomaly, restrictive/intact atrial septum, and prematurity/weight < 2 kg. Early and midterm outcomes were compared in the matched hybrid vs Norwood groups. RESULTS The study included 96 patients (35 hybrid, 61 Norwood). Despite improved 30-day survival in hybrid patients (91% vs 66%, P < .01), 1-year survival was similar between the hybrid and Norwood groups (46% vs 48%, P = .9). No hybrid patients required dialysis or extracorporeal membrane oxygenation after stage I palliation as compared with 19% and 22% of Norwood patients, respectively (both P < .01). Hybrid patients, however, required more unplanned reinterventions (43% vs 21%, P = .02). CONCLUSIONS There remains significant morbidity and mortality among high-risk single-ventricle infants. Despite an early survival benefit, hybrid stage I palliation has not been associated with improved midterm outcomes at our center.
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10
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Graupner O, Enzensberger C, Axt-Fliedner R. New Aspects in the Diagnosis and Therapy of Fetal Hypoplastic Left Heart Syndrome. Geburtshilfe Frauenheilkd 2019; 79:863-872. [PMID: 31423021 PMCID: PMC6690741 DOI: 10.1055/a-0828-7968] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2018] [Revised: 12/29/2018] [Accepted: 12/30/2018] [Indexed: 12/26/2022] Open
Abstract
Fetal hypoplastic left heart syndrome (HLHS) is a severe congenital heart disease with a lethal prognosis without postnatal therapeutic intervention or surgery. The aim of this article is to give a brief overview of new findings in the field of prenatal diagnosis and the therapy of HLHS. As cardiac output in HLHS children depends on the right ventricle (RV), prenatal assessment of fetal RV function is of interest to predict poor functional RV status before the RV becomes the systemic ventricle. Prenatal cardiac interventions such as fetal aortic valvuloplasty and non-invasive procedures such as maternal hyperoxygenation seem to be promising treatment options but will need to be evaluated with regard to long-term outcomes. Novel approaches such as stem cell therapy or neuroprotection provide important clues about the complexity of the disease. New aspects in diagnostics and therapy of HLHS show the potential of a targeted prenatal treatment planning. This could be used to optimize parental counseling as well as pre- and postnatal management of affected children.
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Affiliation(s)
- Oliver Graupner
- Department of Obstetrics and Gynecology, University Hospital rechts der Isar, Technical University of Munich, Munich, Germany
| | - Christian Enzensberger
- Department of Obstetrics and Gynecology, Division of Prenatal Medicine, University Hospital UKGM, Justus-Liebig University, Giessen, Germany
| | - Roland Axt-Fliedner
- Department of Obstetrics and Gynecology, Division of Prenatal Medicine, University Hospital UKGM, Justus-Liebig University, Giessen, Germany
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11
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Cao JY, Lee SY, Phan K, Ayer J, Celermajer DS, Winlaw DS. Early Outcomes of Hypoplastic Left Heart Syndrome Infants: Meta-Analysis of Studies Comparing the Hybrid and Norwood Procedures. World J Pediatr Congenit Heart Surg 2018; 9:224-233. [PMID: 29544421 DOI: 10.1177/2150135117752896] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
The hybrid strategy is an alternative to the traditional Norwood procedure for initial palliation of infants with hypoplastic left heart syndrome (HLHS) who are deemed to be at high surgical risk. Numerous single-center studies have compared the two procedures, showing similar early outcomes, although the cohort sizes are likely insufficiently powered to detect significant differences. The current meta-analysis aims to explore the early morbidity and mortality associated with the hybrid compared to the Norwood procedure. MEDLINE, Cochrane Libraries, and Embase were systematically searched, and 14 studies were included for statistical synthesis, comprising 263 hybrid and 426 Norwood patients. Early mortality was significantly higher in the hybrid patients (relative risk [RR] = 1.54, P < .05, 95% confidence interval [CI]: 1.02-2.34), whereas interstage mortality was comparable between the two groups (RR = 0.88, P > .05, 95% CI: 0.46-1.70). Six-month (RR = 0.89, P < .05, 95% CI: 0.80-1.00) and one-year (RR = 0.88, P < .05, 95% CI: 0.78-1.00) transplant-free survival was also inferior among the hybrid patients. Furthermore, the hybrid patients required more reinterventions following initial surgical palliation (RR = 1.48, P < .05, 95% CI: 1.09-2.01), although the two groups had comparable length of hospital and intensive care unit stay postoperatively. In conclusion, our results suggest that the hybrid procedure is associated with worse early survival compared to the traditional Norwood when used for initial palliation of infants with HLHS. However, due to the hybrid being used preferentially for high-risk patients, definitive conclusions regarding the efficacy of the procedure cannot be drawn.
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Affiliation(s)
- Jacob Y Cao
- 1 Sydney Medical School, University of Sydney, Sydney, New South Wales, Australia
| | - Seung Yeon Lee
- 1 Sydney Medical School, University of Sydney, Sydney, New South Wales, Australia
| | - Kevin Phan
- 1 Sydney Medical School, University of Sydney, Sydney, New South Wales, Australia.,2 NeuroSpine Surgery Research Group (NSURG), Prince of Wales Private Hospital, Sydney, New South Wales, Australia
| | - Julian Ayer
- 1 Sydney Medical School, University of Sydney, Sydney, New South Wales, Australia.,3 Heart Centre for Children, The Children's Hospital at Westmead, Sydney, New South Wales, Australia
| | - David S Celermajer
- 1 Sydney Medical School, University of Sydney, Sydney, New South Wales, Australia.,4 Cardiology, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia
| | - David S Winlaw
- 1 Sydney Medical School, University of Sydney, Sydney, New South Wales, Australia.,3 Heart Centre for Children, The Children's Hospital at Westmead, Sydney, New South Wales, Australia
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12
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Simsic JM, Phelps C, Kirchner K, Carpenito K, Allen R, Miller‐Tate H, Texter K, Galantowicz M. Interstage outcomes in single ventricle patients undergoing hybrid stage 1 palliation. CONGENIT HEART DIS 2018; 13:757-763. [DOI: 10.1111/chd.12649] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/30/2017] [Revised: 04/24/2018] [Accepted: 06/16/2018] [Indexed: 11/28/2022]
Affiliation(s)
- Janet M. Simsic
- The Heart Center at Nationwide Children’s Hospital Columbus Ohio
| | - Christina Phelps
- The Heart Center at Nationwide Children’s Hospital Columbus Ohio
| | - Kristin Kirchner
- The Heart Center at Nationwide Children’s Hospital Columbus Ohio
| | | | - Robin Allen
- The Heart Center at Nationwide Children’s Hospital Columbus Ohio
| | | | - Karen Texter
- The Heart Center at Nationwide Children’s Hospital Columbus Ohio
| | - Mark Galantowicz
- The Heart Center at Nationwide Children’s Hospital Columbus Ohio
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13
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Affiliation(s)
- Dietmar Schranz
- Pediatric Cardiology, Johann-Wolfgang Goethe University Frankfurt, Frankfurt, Germany
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14
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Son JS, James A, Fan CPS, Mertens L, McCrindle BW, Manlhiot C, Friedberg MK. Prognostic Value of Serial Echocardiography in Hypoplastic Left Heart Syndrome. Circ Cardiovasc Imaging 2018; 11:e006983. [DOI: 10.1161/circimaging.117.006983] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/10/2017] [Accepted: 05/17/2018] [Indexed: 11/16/2022]
Affiliation(s)
- Jae Sung Son
- Division of Pediatric Cardiology, Konkuk University Medical Center, Konkuk University School of Medicine, Seoul, Korea (J.S.S.)
| | - Adam James
- Division of Cardiology, Labatt Family Heart Centre, Hospital for Sick Children and University of Toronto, ON, Canada (A.J., C.-P.S.F., L.M., B.W.M., C.M., M.K.F.)
| | - Chun-Po Steve Fan
- Division of Cardiology, Labatt Family Heart Centre, Hospital for Sick Children and University of Toronto, ON, Canada (A.J., C.-P.S.F., L.M., B.W.M., C.M., M.K.F.)
| | - Luc Mertens
- Division of Cardiology, Labatt Family Heart Centre, Hospital for Sick Children and University of Toronto, ON, Canada (A.J., C.-P.S.F., L.M., B.W.M., C.M., M.K.F.)
| | - Brian W. McCrindle
- Division of Cardiology, Labatt Family Heart Centre, Hospital for Sick Children and University of Toronto, ON, Canada (A.J., C.-P.S.F., L.M., B.W.M., C.M., M.K.F.)
| | - Cedric Manlhiot
- Division of Cardiology, Labatt Family Heart Centre, Hospital for Sick Children and University of Toronto, ON, Canada (A.J., C.-P.S.F., L.M., B.W.M., C.M., M.K.F.)
| | - Mark K. Friedberg
- Division of Cardiology, Labatt Family Heart Centre, Hospital for Sick Children and University of Toronto, ON, Canada (A.J., C.-P.S.F., L.M., B.W.M., C.M., M.K.F.)
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15
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Nwankwo UT, Morell EM, Trucco SM, Morell VO, Kreutzer J. Hybrid Strategy for Neonates With Ductal-Dependent Systemic Circulation at High Risk for Norwood. Ann Thorac Surg 2018; 106:595-601. [PMID: 29630874 DOI: 10.1016/j.athoracsur.2018.03.007] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/12/2017] [Revised: 02/20/2018] [Accepted: 03/02/2018] [Indexed: 12/20/2022]
Abstract
BACKGROUND Hypoplastic left heart syndrome and other cardiac lesions with ductal-dependent systemic circulation continue to be challenging to manage, especially in high-risk (HR) populations (those with prematurity, multiple congenital anomalies, moderate to severe tricuspid regurgitation, hemodynamic instability, intact atrial septum). METHODS A retrospective study on our institution's experience implementing a hybrid strategy as initial palliation in HR patients with ductal-dependent systemic circulation in HR patients undergoing Norwood versus hybrid procedure. From July 2004 to May 2008, 16 HR patients underwent stage I Norwood procedure. After implementation of a hybrid strategy in 2008, 24 HR patients underwent hybrid procedure from May 2008 to November 2015. RESULTS There was no difference in gestational age, age at procedure, or hospital length of stay. The HR Hybrid group had lower mean weight (2.6 kg vs 3.1 kg, p = 0.026). Thirty-day mortality was lower in the HR Hybrid group (4% vs 31%, p = 0.019), although there was no difference in interstage mortality (17% vs 9%, p = 0.396). Catheter-based reintervention was more prevalent in the HR Hybrid group, but did not have a negative impact on survival. One-year transplant-free survival was similar (p = 0.416). HR Hybrid patients weighing less than 2.6 kg had higher overall survival (83% vs 25%, p = 0.013), as did patients who were premature (70% vs 0%, p = 0.003). CONCLUSIONS In high-risk patients, the hybrid procedure appears to have lower 30-day mortality and may have a survival benefit in premature patients and those less than 2.6 kg. Long-term attrition in this high-risk population is ongoing regardless of early strategy.
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Affiliation(s)
- Ugonna T Nwankwo
- Division of Pediatric Cardiology, Children's Hospital of Pittsburgh of the University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania.
| | - Evonne M Morell
- Division of Pediatric Cardiology, Children's Hospital of Pittsburgh of the University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Sara M Trucco
- Division of Pediatric Cardiology, Children's Hospital of Pittsburgh of the University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Victor O Morell
- Division of Cardiothoracic Surgery, Children's Hospital of Pittsburgh of the University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Jacqueline Kreutzer
- Division of Pediatric Cardiology, Children's Hospital of Pittsburgh of the University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
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16
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Kapravelou E, Anderson D, Morgan GJ. Hybrid Strategy for High-Risk Neonates with Interrupted Aortic Arch: A Can Well Worth Kicking? Int J Angiol 2018; 27:50-53. [PMID: 29483768 PMCID: PMC5825225 DOI: 10.1055/s-0037-1602374] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
Abstract
The use of hybrid techniques to avoid neonatal cardiopulmonary bypass in high-risk individuals is well reported in the setting of hypoplastic left heart syndrome. We describe the use of that technique as a bridging procedure in high-risk neonates with an interrupted aortic arch. We report three cases where hybrid branch pulmonary artery banding and ductal stent implantation has been successfully used to defer complete repair, allowing recovery, maturity, and weight gain. This strategy may be considered for patients deemed at high risk for primary neonatal repair.
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Affiliation(s)
- Eva Kapravelou
- Department of Paediatric Cardiology, Evelina Children's Hospital, London, United Kingdom
| | - David Anderson
- Department of Paediatric Cardiology, Evelina Children's Hospital, London, United Kingdom
| | - Gareth J. Morgan
- Department of Paediatric Cardiology, Evelina Children's Hospital, London, United Kingdom
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17
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Rogers L, Pagel C, Sullivan ID, Mustafa M, Tsang V, Utley M, Bull C, Franklin RC, Brown KL. Interventional treatments and risk factors in patients born with hypoplastic left heart syndrome in England and Wales from 2000 to 2015. Heart 2018; 104:1500-1507. [DOI: 10.1136/heartjnl-2017-312448] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/19/2017] [Revised: 12/18/2017] [Accepted: 12/19/2017] [Indexed: 01/25/2023] Open
Abstract
ObjectiveTo describe the long-term outcomes, treatment pathways and risk factors for patients diagnosed with hypoplastic left heart syndrome (HLHS) in England and Wales.MethodsThe UK’s national audit database captures every procedure undertaken for congenital heart disease and updated life status for resident patients in England and Wales. Patients with HLHS born between 2000 and 2015 were identified using codes from the International Paediatric and Congenital Cardiac Code.ResultsThere were 976 patients with HLHS. Of these, 9.6% had a prepathway intervention, 89.5% underwent a traditional pathway of staged palliation and 6.4% of infants underwent a hybrid pathway. Patients undergoing prepathway procedures or the hybrid pathway were more complex, exhibiting higher rates of prematurity and acquired comorbidity. Prepathway intervention was associated with the highest in-hospital mortality (34.0%).44.6% of patients had an off-pathway procedure after their primary procedure, most frequently stenting or dilation of residual or recoarctation and most commonly occurring between stage 1 and stage 2.The survival rate at 1 year and 5 years was 60.7% (95% CI 57.5 to 63.7) and 56.3% (95% CI 53.0 to 59.5), respectively. Patients with an antenatal diagnosis (multivariable HR (MHR) 1.63 (95% CI 1.12 to 2.38)), low weight (<2.5 kg) (MHR 1.49 (95% CI 1.05 to 2.11)) or the presence of an acquired comorbidity (MHR 2.04 (95% CI 1.30 to 3.19)) were less likely to survive.ConclusionTreatment pathways among patients with HLHS are complex and variable. It is essential that the long-term outcomes of conditions like HLHS that require serial interventions are studied to provide a fuller picture and to inform quality assurance and improvement.
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18
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Desai J, Aggarwal S, Lipshultz S, Agarwal P, Yigazu P, Patel R, Seals S, Natarajan G. Surgical Interventions in Infants Born Preterm with Congenital Heart Defects: An Analysis of the Kids' Inpatient Database. J Pediatr 2017; 191:103-109.e4. [PMID: 28964428 DOI: 10.1016/j.jpeds.2017.07.015] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2016] [Revised: 06/16/2017] [Accepted: 07/07/2017] [Indexed: 10/18/2022]
Abstract
OBJECTIVE To evaluate short-term outcomes in infants born preterm with congenital heart defects (CHDs) and the factors associated with surgery, survival, and length of hospitalization in this population. STUDY DESIGN We analyzed data from infants born preterm (gestational age <37 weeks) enrolled in the multicenter Kids' Inpatient Database of the Healthcare Cost and Utilization Project who were admitted to the hospital within 30 days after birth. Infants with atrial septal defects were excluded. RESULTS Of 1 429 762 enrolled infants born preterm, 27 434 (2.0%) with CHDs were included. Overall survival to discharge was 90.5%; 74.0% among infants with critical CHDs and 45.7% among infants with hypoplastic left heart syndrome. Cardiac surgeries were performed in 12.2% of all infants born preterm. Rates of surgical intervention for infants with critical CHDs were lower for very low birth weight (≤1.5 kg) vs larger infants >1.5 kg (27% vs 44%), and only 6.3% of infants born with very low birth weight underwent surgeries in Risk-adjustment for Congenital Heart Surgery categories 4 or greater. Greater birth weight, left-sided lesions, care at children's hospitals, and absence of trisomies were associated with a greater likelihood of surgery. Birth weight <2 kg, nonwhite race, trisomy syndromes, prematurity-related morbidities, and Risk-adjustment for Congenital Heart Surgery category 4 or greater were independent predictors of mortality. Birth weight <2 kg, Risk-adjustment for Congenital Heart Surgery category, morbidities, and sidedness of lesion predicted length of stay. CONCLUSIONS The high survival rates of infants born preterm with CHDs suggests that a cautiously optimistic approach to surgery may be warranted in all but the most immature infants with the greatest-risk conditions.
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Affiliation(s)
- Jagdish Desai
- Department of Pediatrics, University of Mississippi Medical Center, Jackson, MS; Division of Neonatology, Children's Hospital of Michigan, Wayne State University, Detroit, MI.
| | - Sanjeev Aggarwal
- Division of Pediatric Cardiology, Children's Hospital of Michigan, Wayne State University, Detroit, MI
| | - Steven Lipshultz
- Division of Pediatric Cardiology, Children's Hospital of Michigan, Wayne State University, Detroit, MI
| | - Prashant Agarwal
- Division of Neonatology, Children's Hospital of Michigan, Wayne State University, Detroit, MI
| | - Paulos Yigazu
- Division of Neonatology, Children's Hospital of Michigan, Wayne State University, Detroit, MI
| | - Riddhiben Patel
- Division of Child Neurology, University of Mississippi Medical Center, Jackson, MS
| | - Samantha Seals
- Center of Biostatistics & Bioinformatics, University of Mississippi Medical Center, Jackson, MS
| | - Girija Natarajan
- Division of Neonatology, Children's Hospital of Michigan, Wayne State University, Detroit, MI
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19
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Latus H, Nassar MS, Wong J, Hachmann P, Bellsham-Revell H, Hussain T, Apitz C, Salih C, Austin C, Anderson D, Yerebakan C, Akintuerk H, Bauer J, Razavi R, Schranz D, Greil G. Ventricular function and vascular dimensions after Norwood and hybrid palliation of hypoplastic left heart syndrome. Heart 2017; 104:244-252. [DOI: 10.1136/heartjnl-2017-311532] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2017] [Revised: 05/29/2017] [Accepted: 06/22/2017] [Indexed: 11/04/2022] Open
Abstract
ObjectiveNorwood and hybrid procedure are two options available for initial palliation of patients with hypoplastic left heart syndrome (HLHS). Our study aimed to assess potential differences in right ventricular (RV) function and pulmonary artery dimensions using cardiac magnetic resonance (CMR) in survivors with HLHS.Methods42 Norwood (mean age 2.4±0.8) and 44 hybrid (mean age 2.0±1.0 years) patients were evaluated by CMR after stage II palliation prior to planned Fontan completion. Initial stage I Norwood procedure was performed using a modified Blalock-Taussig shunt, while the hybrid procedure consisted of bilateral pulmonary artery banding and arterial duct stenting. Need for reinterventions and subsequent outcomes were also assessed.ResultsNorwood patients had larger RV end-diastolic dimensions (91±23 vs 80±31 mL/m2, p=0.004) and lower heart rate (90±15 vs 102±13, p<0.001) than hybrid patients. Both Norwood and hybrid patients showed preserved global RV pump function (59±9 vs 59%±10%, p=0.91), while RV strain, strain rate and intraventricular synchrony were superior in the Norwood group. Pulmonary artery size was reduced (lower lobe index 135±74 vs 161±62 mm2/m2, p=0.02), and reintervention rate was significantly higher in the hybrid group whereas subsequent outcome did not differ significantly (p=0.24).ConclusionsNorwood and hybrid strategy were associated with equivalent and preserved global RV pump function while development of the pulmonary arteries and reintervention rate were superior using the Norwood approach. Impaired RV myocardial deformation as a potential marker of early RV dysfunction in the hybrid group may have a negative long-term impact in this population.
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20
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Comparison of self-expandable and balloon-expanding stents for hybrid ductal stenting in hypoplastic left heart complex. Cardiol Young 2017; 27:837-845. [PMID: 28555538 DOI: 10.1017/s1047951116001347] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
OBJECTIVES We aimed to compare the procedural and mid-term performance of a specifically designed self-expanding stent with balloon-expandable stents in patients undergoing hybrid palliation for hypoplastic left heart syndrome and its variants. BACKGROUND The lack of specifically designed stents has led to off-label use of coronary, biliary, or peripheral stents in the neonatal ductus arteriosus. Recently, a self-expanding stent, specifically designed for use in hypoplastic left heart syndrome, has become available. METHODS We carried out a retrospective cohort comparison of 69 neonates who underwent hybrid ductal stenting with balloon-expandable and self-expanding stents from December, 2005 to July, 2014. RESULTS In total, 43 balloon-expandable stents were implanted in 41 neonates and more recently 47 self-expanding stents in 28 neonates. In the balloon-expandable stents group, stent-related complications occurred in nine patients (22%), compared with one patient in the self-expanding stent group (4%). During follow-up, percutaneous re-intervention related to the ductal stent was performed in five patients (17%) in the balloon-expandable stent group and seven patients (28%) in self-expanding stents group. CONCLUSIONS Hybrid ductal stenting with self-expanding stents produced favourable results when compared with the results obtained with balloon-expandable stents. Immediate additional interventions and follow-up re-interventions were similar in both groups with complications more common in those with balloon-expandable stents.
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21
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Goreczny S, Morgan GJ, Dryzek P, Moll J, Moszura T. Initial experience with live three-dimensional image overlay for ductal stenting in hypoplastic left heart syndrome. EUROINTERVENTION 2016; 12:1527-1533. [DOI: 10.4244/eij-d-15-00101] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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22
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Moore J, Paulus D, Cua CL, Kertesz NJ, Miao Y, Cheatham JP, Galantowicz M, Fernandez R. Arrhythmias After Stage I Hybrid Palliation in Single-Ventricle Patients. Pediatr Cardiol 2016; 37:1416-1421. [PMID: 27425423 DOI: 10.1007/s00246-016-1450-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/07/2016] [Accepted: 05/24/2016] [Indexed: 11/29/2022]
Abstract
The hybrid procedure is an alternative palliative strategy for patients with single-ventricle physiology. No data exist documenting the incidence of arrhythmias after the hybrid procedure. Goal of this study was to determine the incidence and type of arrhythmias in patients undergoing the hybrid procedure. A retrospective chart review was performed including all patients undergoing the hybrid procedure between January of 2010 through December of 2013. Sixty-five patients underwent the hybrid procedure during this time period (43 HLHS, 22 other). Average gestational age at admission was 37.7 weeks. Average age at time of procedure was 7.6 days. Five patients had documented arrhythmias (7.7 %). Four were supraventricular tachycardias, and 1 was a sinus bradycardia. One patient with arrhythmia died during hospitalization, and another patient with arrhythmia died during the interstage period. Hybrid palliation for patients with single-ventricle physiology has a low incidence of arrhythmias. In this cohort of patients, arrhythmias did not contribute to mortality. There was a trend toward association between arrhythmias and longer total length of hospital stay.
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Affiliation(s)
- Jeffrey Moore
- Nationwide Children's Hospital, 700 Children's Dr., Columbus, OH, 43205-2664, USA.
| | - Diane Paulus
- Nationwide Children's Hospital, 700 Children's Dr., Columbus, OH, 43205-2664, USA
| | - Clifford L Cua
- Nationwide Children's Hospital, 700 Children's Dr., Columbus, OH, 43205-2664, USA
| | - Naomi J Kertesz
- Nationwide Children's Hospital, 700 Children's Dr., Columbus, OH, 43205-2664, USA
| | - Yongjie Miao
- Nationwide Children's Hospital, 700 Children's Dr., Columbus, OH, 43205-2664, USA
| | - John P Cheatham
- Nationwide Children's Hospital, 700 Children's Dr., Columbus, OH, 43205-2664, USA
| | - Mark Galantowicz
- Nationwide Children's Hospital, 700 Children's Dr., Columbus, OH, 43205-2664, USA
| | - Richard Fernandez
- Nationwide Children's Hospital, 700 Children's Dr., Columbus, OH, 43205-2664, USA
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23
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Wilder TJ, McCrindle BW, Hickey EJ, Ziemer G, Tchervenkov CI, Jacobs ML, Gruber PJ, Blackstone EH, Williams WG, DeCampli WM, Caldarone CA, Pizarro C. Is a hybrid strategy a lower-risk alternative to stage 1 Norwood operation? J Thorac Cardiovasc Surg 2016; 153:163-172.e6. [PMID: 27671550 DOI: 10.1016/j.jtcvs.2016.08.021] [Citation(s) in RCA: 45] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/24/2016] [Revised: 07/17/2016] [Accepted: 08/06/2016] [Indexed: 11/19/2022]
Abstract
BACKGROUND For neonates with critical left ventricular outflow tract obstruction (LVOTO), hybrid procedures are an alternative to the Norwood stage 1 procedure. Despite perceived advantages, however, outcomes are not well defined. Therefore, we compared outcomes after stage 1 hybrid and Norwood procedures. METHODS In a critical LVOTO inception cohort (2005-2014; 20 institutions), a total of 564 neonates underwent stage 1 palliation with the Norwood operation with a modified Blalock-Taussig shunt (NW-BT; n = 232; 41%), Norwood operation with a right ventricle-to-pulmonary artery conduit (NW-RVPA; n = 222; 39%), or a hybrid procedure (n = 110; 20%). Post-stage 1 outcomes were analyzed via competing-risks and parametric hazard analyses and compared among all 564 patients and between patients who underwent propensity-matched hybrid and those who underwent NW-BT/NW-RVPA. RESULTS By 6 years after the stage 1 operation, 50% ± 3%, 7% ± 2%, and 4% ± 1% of patients transitioned to Fontan, transplantation, and biventricular repair, respectively, whereas 7% ± 2% were alive without transition and 32% ± 2% died. Risk factors for death without transition included procedure type, smaller ascending aorta, aortic valve atresia, and lower birth weight. Risk-adjusted 4-year survival was better after NW-RVPA than after NW-BT or hybrid (76% vs 60% vs 61%; P < .001). Furthermore, for neonates with lower birth weight (<∼2 kg), an interaction between birth weight and hybrid resulted in a trend toward better survival after hybrid compared with NW-BT or NW-RVPA. For propensity-matched neonates between hybrid and NW-BT (88 pairs), 4-year survival was similar (62% vs 57%; P = .58). For propensity-matched neonates between hybrid and NW-RVPA (81 pairs), 4-year survival was better after NW-RVPA (59% vs 75%; P = .008). CONCLUSIONS For neonates with critical LVOTO undergoing single-ventricle palliation, NW-RVPA was associated with the best overall survival. Hybrid strategies are not a lower-risk alternative to Norwood operations overall; however, the impact of lower birth weight on survival may be mitigated after hybrid procedures compared with Norwood operations.
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Affiliation(s)
- Travis J Wilder
- Congenital Heart Surgeons' Society Data Center, University of Toronto, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Brian W McCrindle
- Division of Pediatric Cardiology, Department of Pediatrics, University of Toronto, The Hospital for Sick Children, Toronto, Ontario, Canada.
| | - Edward J Hickey
- Department of Cardiovascular Surgery, University of Toronto, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Gerhard Ziemer
- Division of Cardiac and Thoracic Surgery, Department of Surgery, University of Chicago Medicine, Chicago, Ill
| | - Christo I Tchervenkov
- Department of Cardiothoracic Surgery, Montreal Children's Hospital of the McGill University Health Center, Montreal, Quebec, Canada
| | - Marshall L Jacobs
- Department of Surgery, Johns Hopkins School of Medicine, Baltimore, Md
| | - Peter J Gruber
- Division of Cardiothoracic Surgery, Department of Surgery, University of Iowa Carver College of Medicine, Iowa City, Iowa
| | | | - William G Williams
- Congenital Heart Surgeons' Society Data Center, University of Toronto, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - William M DeCampli
- Department of Cardiothoracic Surgery, Arnold Palmer Hospital for Children, Orlando, Fla
| | - Christopher A Caldarone
- Department of Cardiovascular Surgery, University of Toronto, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Christian Pizarro
- Nemours Cardiac Center, Alfred I. DuPont Hospital for Children, Wilmington, Del
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24
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Evans WN, Galindo A, Rothman A, Ciccolo ML, Carrillo SA, Acherman RJ, Mayman GA, Cass KA, Kip KT, Luna CF, Ludwick JM, Rollins RC, Castillo WJ, Alexander JA, Restrepo H. Hybrid Palliation for Ductal-Dependent Systemic Circulation. Pediatr Cardiol 2016; 37:868-77. [PMID: 26932364 DOI: 10.1007/s00246-016-1361-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/26/2015] [Accepted: 02/13/2016] [Indexed: 12/01/2022]
Abstract
We reviewed our hybrid palliation experience for 91 neonates, with ductal-dependent systemic circulation, born between August 2007 and October 2015. For analysis, we stratified the 91 patients by a risk factor (RF) score and divided them into three groups: (1) high-risk two-functional ventricles (2V) median RF score of 3 (N = 20); (2) low-risk one-functional ventricle (1V) RF score 0-1 (N = 32); and (3) high-risk 1V RF score ≥2 (N = 39). Midterm survival (median 4 years) by group was: (1) 95 %, (2) 91 %, and (3) 15 %, (p = 0.001). In conclusion, hybrid palliation was associated with excellent midterm results for high-risk 2V and low-risk 1V patients with ductal-dependent systemic circulation. In contrast, high-risk 1V patients had significantly worse outcomes.
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Affiliation(s)
- William N Evans
- Children's Heart Center Nevada, 3006 S. Maryland Pkwy Ste. 690, Las Vegas, NV, 89109, USA. .,Division of Pediatric Cardiology, Department of Pediatrics, University of Nevada School of Medicine, 2040 W. Charleston Blvd Ste. 402, Las Vegas, NV, 89109, USA.
| | - Alvaro Galindo
- Children's Heart Center Nevada, 3006 S. Maryland Pkwy Ste. 690, Las Vegas, NV, 89109, USA.,Division of Pediatric Cardiology, Department of Pediatrics, University of Nevada School of Medicine, 2040 W. Charleston Blvd Ste. 402, Las Vegas, NV, 89109, USA
| | - Abraham Rothman
- Children's Heart Center Nevada, 3006 S. Maryland Pkwy Ste. 690, Las Vegas, NV, 89109, USA.,Division of Pediatric Cardiology, Department of Pediatrics, University of Nevada School of Medicine, 2040 W. Charleston Blvd Ste. 402, Las Vegas, NV, 89109, USA
| | - Michael L Ciccolo
- Children's Heart Center Nevada, 3006 S. Maryland Pkwy Ste. 690, Las Vegas, NV, 89109, USA.,Department of Surgery, University of Nevada School of Medicine, 2040 W. Charleston Blvd Ste. 402, Las Vegas, NV, 89109, USA
| | - Sergio A Carrillo
- Children's Heart Center Nevada, 3006 S. Maryland Pkwy Ste. 690, Las Vegas, NV, 89109, USA.,Department of Surgery, University of Nevada School of Medicine, 2040 W. Charleston Blvd Ste. 402, Las Vegas, NV, 89109, USA
| | - Ruben J Acherman
- Children's Heart Center Nevada, 3006 S. Maryland Pkwy Ste. 690, Las Vegas, NV, 89109, USA.,Division of Pediatric Cardiology, Department of Pediatrics, University of Nevada School of Medicine, 2040 W. Charleston Blvd Ste. 402, Las Vegas, NV, 89109, USA
| | - Gary A Mayman
- Children's Heart Center Nevada, 3006 S. Maryland Pkwy Ste. 690, Las Vegas, NV, 89109, USA.,Division of Pediatric Cardiology, Department of Pediatrics, University of Nevada School of Medicine, 2040 W. Charleston Blvd Ste. 402, Las Vegas, NV, 89109, USA
| | - Kathleen A Cass
- Children's Heart Center Nevada, 3006 S. Maryland Pkwy Ste. 690, Las Vegas, NV, 89109, USA.,Division of Pediatric Cardiology, Department of Pediatrics, University of Nevada School of Medicine, 2040 W. Charleston Blvd Ste. 402, Las Vegas, NV, 89109, USA
| | - Katrinka T Kip
- Children's Heart Center Nevada, 3006 S. Maryland Pkwy Ste. 690, Las Vegas, NV, 89109, USA.,Division of Pediatric Cardiology, Department of Pediatrics, University of Nevada School of Medicine, 2040 W. Charleston Blvd Ste. 402, Las Vegas, NV, 89109, USA
| | - Carlos F Luna
- Children's Heart Center Nevada, 3006 S. Maryland Pkwy Ste. 690, Las Vegas, NV, 89109, USA.,Division of Pediatric Cardiology, Department of Pediatrics, University of Nevada School of Medicine, 2040 W. Charleston Blvd Ste. 402, Las Vegas, NV, 89109, USA
| | - Joseph M Ludwick
- Children's Heart Center Nevada, 3006 S. Maryland Pkwy Ste. 690, Las Vegas, NV, 89109, USA.,Division of Pediatric Cardiology, Department of Pediatrics, University of Nevada School of Medicine, 2040 W. Charleston Blvd Ste. 402, Las Vegas, NV, 89109, USA
| | - Robert C Rollins
- Children's Heart Center Nevada, 3006 S. Maryland Pkwy Ste. 690, Las Vegas, NV, 89109, USA.,Division of Pediatric Cardiology, Department of Pediatrics, University of Nevada School of Medicine, 2040 W. Charleston Blvd Ste. 402, Las Vegas, NV, 89109, USA
| | - William J Castillo
- Children's Heart Center Nevada, 3006 S. Maryland Pkwy Ste. 690, Las Vegas, NV, 89109, USA.,Division of Pediatric Cardiology, Department of Pediatrics, University of Nevada School of Medicine, 2040 W. Charleston Blvd Ste. 402, Las Vegas, NV, 89109, USA
| | - John A Alexander
- Children's Heart Center Nevada, 3006 S. Maryland Pkwy Ste. 690, Las Vegas, NV, 89109, USA.,Division of Pediatric Cardiology, Department of Pediatrics, University of Nevada School of Medicine, 2040 W. Charleston Blvd Ste. 402, Las Vegas, NV, 89109, USA
| | - Humberto Restrepo
- Children's Heart Center Nevada, 3006 S. Maryland Pkwy Ste. 690, Las Vegas, NV, 89109, USA.,Division of Pediatric Cardiology, Department of Pediatrics, University of Nevada School of Medicine, 2040 W. Charleston Blvd Ste. 402, Las Vegas, NV, 89109, USA
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Lee SM, Kwon JE, Song SH, Kim GB, Park JY, Kim BJ, Lee JH, Park CW, Park JS, Jun JK. Prenatal prediction of neonatal death in single ventricle congenital heart disease. Prenat Diagn 2016; 36:346-52. [DOI: 10.1002/pd.4787] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2015] [Revised: 01/04/2016] [Accepted: 01/30/2016] [Indexed: 11/07/2022]
Affiliation(s)
- Seung Mi Lee
- Department of Obstetrics and Gynecology; Seoul National University College of Medicine; Seoul Korea
- Department of Obstetrics and Gynecology; Seoul Metropolitan Government Seoul National University Boramae Medical Center; Seoul Korea
| | - Jeong Eun Kwon
- Department of Obstetrics and Gynecology; Seoul National University College of Medicine; Seoul Korea
| | - Sang Hoon Song
- Department of Laboratory Medicine; Seoul National University College of Medicine; Seoul Korea
| | - Gi. Beom Kim
- Department of Pediatrics; Seoul National University College of Medicine; Seoul Korea
| | - Jung Yeon Park
- Department of Obstetrics and Gynecology; Seoul National University College of Medicine; Seoul Korea
| | - Byoung Jae Kim
- Department of Obstetrics and Gynecology; Seoul National University College of Medicine; Seoul Korea
- Department of Obstetrics and Gynecology; Seoul Metropolitan Government Seoul National University Boramae Medical Center; Seoul Korea
| | - Joon Ho Lee
- Department of Obstetrics and Gynecology; Seoul National University College of Medicine; Seoul Korea
| | - Chan-Wook Park
- Department of Obstetrics and Gynecology; Seoul National University College of Medicine; Seoul Korea
| | - Joong Shin Park
- Department of Obstetrics and Gynecology; Seoul National University College of Medicine; Seoul Korea
| | - Jong Kwan Jun
- Department of Obstetrics and Gynecology; Seoul National University College of Medicine; Seoul Korea
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Extended Application of the Hybrid Procedure in Neonates with Left-Sided Obstructive Lesions in an Evolving Cardiac Program. Pediatr Cardiol 2016; 37:465-71. [PMID: 26538212 DOI: 10.1007/s00246-015-1301-7] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/14/2015] [Accepted: 10/20/2015] [Indexed: 10/22/2022]
Abstract
The hybrid approach to management of hypoplastic left heart syndrome (HLHS) was developed as an alternative to neonatal Norwood surgery, providing a less invasive initial palliation for HLHS. We describe our experience in extending the concept of the hybrid procedure to palliate neonates with anatomically compromised systemic arterial blood flow in a variety of congenital cardiac anomalies and supporting its application as first-line palliation in centers developing their HLHS programs. Retrospective review of patients undergoing therapy for HLHS at a single institution from June 2008 to December 2014 was performed. Subject demographics, clinical and procedural data, along with follow-up, were collected. Thirteen patients had initial hybrid palliation for HLHS during the time frame indicated at a median age of 8 days (range 1-29 days) and median weight of 3.4 kg (range 2.4-4.6 kg). Diagnoses included typical HLHS (n = 6), right-dominant unbalanced atrioventricular septal defect with arch hypoplasia (n = 4), double outlet right ventricle [subpulmonic VSD (n = 1) and intact ventricular septum (n = 1)] with hypoplastic transverse aortic arch and borderline left ventricular dimensions. Standard approach with bilateral pulmonary artery banding and ductal stenting was carried out in all thirteen patients. Two patients required two ductal stents at the time of index procedure. There were no intraprocedural complications. Median intubation length post-procedure was 4 days (range 1-74 days). Median hospital stay post-procedure was 47 days (range 15-270 days). The overall mortality rate on follow-up through comprehensive stage 2 over the 6-year experience was 38 % (5 out of 13). Of note, the mortality rate was significantly lower in the latter 3 years of the study period when the procedure was adopted as a primary palliation for HLHS (14 % or 1 out of 7) compared to the initial 3-year period when it was reserved for higher risk cohorts (67 % or 4 out of 6). Median time to subsequent surgery was 3 months (range 1-4 months). One patient required further ductal stenting on follow-up and developed subsequently airway compression. On median follow-up of 24 months, two patients required pulmonary artery arterioplasty. The hybrid procedure may be used for palliation for a variety of cardiac lesions to avoid high-risk surgery in the neonatal period. This approach may be also an alternative in centers performing lower number of Norwood surgery, which has been associated with higher mortality.
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Murphy MO, Bellsham-Revell H, Morgan GJ, Krasemann T, Rosenthal E, Qureshi SA, Salih C, Austin CB, Anderson DR. Hybrid Procedure for Neonates With Hypoplastic Left Heart Syndrome at High-Risk for Norwood: Midterm Outcomes. Ann Thorac Surg 2015; 100:2286-90; discussion 2291-2. [PMID: 26433522 DOI: 10.1016/j.athoracsur.2015.06.098] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2015] [Revised: 05/17/2015] [Accepted: 06/26/2015] [Indexed: 01/08/2023]
Abstract
BACKGROUND Hybrid procedure offers patients with severe congenital heart disease an alternative initial procedure to conventional surgical reconstruction. We report the midterm outcomes of a cohort of neonates who had a hybrid procedure for variants of hypoplastic left heart syndrome because they were at high risk for the Norwood procedure. METHODS Between December 2005 and January 2013, 41 neonates underwent bilateral pulmonary artery banding followed by ductal stenting by means of a sternotomy at a median age of 6 days (range, 2 to 18 days) and weight of 2.6 kg (range, 1.5 to 3.7 kg). Thirty-five patients had hypoplastic left heart syndrome, and 6 patients had critical aortic stenosis with hypoplastic left ventricle. Primary indications for the hybrid procedure were low birth weight in 17 patients, hypoplastic left ventricle with the possibility of later biventricular repair in 6 patients, intact or near-intact atrial septum in 5 patients, and poor patient condition in 13 patients. Echocardiographic, angiographic, operative, and clinical data were reviewed. Outcomes were summarized with descriptive statistics and risk factors for mortality identified. RESULTS All but 6 patients had an antenatal diagnosis, and 24 patients were from other congenital cardiac centers. Nine patients had perioperative balloon aortic valvuloplasty, 1 patient had fetal balloon aortic valvuloplasty, and 17 patients had intervention to their atrial septum (41.4%). There were 9 inpatient deaths (21.9%) and 4 interstage deaths (9.8%) after the hybrid procedure. Twenty-eight patients subsequently underwent either the Norwood procedure (11 patients), combined stage I and II (14 patients), or biventricular repair (3 patients). No patient had heart transplantation. Among the patients who had combined stage I and II as a second procedure after the hybrid procedure, there were 2 early deaths, 1 late death before the Fontan, and 1 late death after the Fontan completion after combined stage I and II. All patients who had subsequent Norwood procedure were midterm survivors. Three of the 4 patients who had biventricular repair were midterm survivors. Overall survival was 56.1% at a median follow-up of 32.0 months. By univariate analysis, patient factors, intact or near-intact atrial septum, and aortic atresia were associated with nonsurvival. CONCLUSIONS Hybrid procedure as an alternative to the Norwood procedure offers good midterm survival in patients deemed at high risk for neonatal reconstruction.
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Affiliation(s)
- Michael O Murphy
- Department of Cardiology and Cardiac Surgery, Evelina London Children's Hospital, Guy's & St. Thomas' NHS Foundation Trust, London, United Kingdom.
| | - Hannah Bellsham-Revell
- Department of Cardiology and Cardiac Surgery, Evelina London Children's Hospital, Guy's & St. Thomas' NHS Foundation Trust, London, United Kingdom
| | - Gareth J Morgan
- Department of Cardiology and Cardiac Surgery, Evelina London Children's Hospital, Guy's & St. Thomas' NHS Foundation Trust, London, United Kingdom
| | - Thomas Krasemann
- Department of Cardiology and Cardiac Surgery, Evelina London Children's Hospital, Guy's & St. Thomas' NHS Foundation Trust, London, United Kingdom
| | - Eric Rosenthal
- Department of Cardiology and Cardiac Surgery, Evelina London Children's Hospital, Guy's & St. Thomas' NHS Foundation Trust, London, United Kingdom
| | - Shakeel A Qureshi
- Department of Cardiology and Cardiac Surgery, Evelina London Children's Hospital, Guy's & St. Thomas' NHS Foundation Trust, London, United Kingdom
| | - Caner Salih
- Department of Cardiology and Cardiac Surgery, Evelina London Children's Hospital, Guy's & St. Thomas' NHS Foundation Trust, London, United Kingdom
| | - Conal B Austin
- Department of Cardiology and Cardiac Surgery, Evelina London Children's Hospital, Guy's & St. Thomas' NHS Foundation Trust, London, United Kingdom
| | - David R Anderson
- Department of Cardiology and Cardiac Surgery, Evelina London Children's Hospital, Guy's & St. Thomas' NHS Foundation Trust, London, United Kingdom
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Second stage after initial hybrid palliation for hypoplastic left heart syndrome: Arterial or venous shunt? J Thorac Cardiovasc Surg 2015; 150:350-7. [DOI: 10.1016/j.jtcvs.2015.04.039] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2015] [Revised: 03/28/2015] [Accepted: 04/18/2015] [Indexed: 11/19/2022]
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Bentham JR, Thomson JDR. Current state of interventional cardiology in congenital heart disease. Arch Dis Child 2015; 100:787-92. [PMID: 25678596 DOI: 10.1136/archdischild-2014-306052] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/09/2014] [Accepted: 01/07/2015] [Indexed: 11/03/2022]
Abstract
Congenital interventional cardiology seeks to provide alternative percutaneous solutions to congenital cardiac problems in preference to more traditional surgical approaches. Simpler procedures have been refined and are now achievable in smaller children and infants. More complex procedures are increasingly recognised as superior to surgical alternatives, though most patients with complex disease inevitably undergo combinations of interventional, surgical and joint or hybrid procedures. This review seeks to highlight recent advances in these techniques of most interest to the readership of this journal.
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Affiliation(s)
- J R Bentham
- Department of Congenital cardiology, Yorkshire Heart Centre, Leeds General Infirmary, Leeds, UK
| | - J D R Thomson
- Department of Congenital cardiology, Yorkshire Heart Centre, Leeds General Infirmary, Leeds, UK
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Trezzi M, Cetrano E, Carotti A. Hybrid palliation for hypoplastic left heart syndrome: Navigating the gray zone. J Thorac Cardiovasc Surg 2015. [PMID: 26204875 DOI: 10.1016/j.jtcvs.2015.03.039] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Affiliation(s)
- Matteo Trezzi
- Children Hospital Bambino Gesù I.R.C.C.S., Rome, Italy
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DeCampli WM, Fleishman CE, Nykanen DG. Hybrid approach to the comprehensive stage II operation in a subset of single-ventricle variants. J Thorac Cardiovasc Surg 2015; 149:1095-100. [DOI: 10.1016/j.jtcvs.2014.11.081] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/08/2014] [Revised: 11/21/2014] [Accepted: 11/29/2014] [Indexed: 11/28/2022]
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Goreczny S, Qureshi S, Rosenthal E, Krasemann T, Bedair R, Salih C, Austin C, Anderson D, Morgan GJ. Self-expanding stent implantation in arterial duct during hybrid palliation of hypoplastic left heart syndrome: midterm experience with a specially designed stent. EUROINTERVENTION 2015; 10:1318-25. [DOI: 10.4244/eijy15m01_08] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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Schranz D. Comments to: Aristotle Score for ''Hybrid Procedure''. Pediatr Cardiol 2015; 36:456. [PMID: 25511665 DOI: 10.1007/s00246-014-1077-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/03/2014] [Accepted: 12/01/2014] [Indexed: 11/26/2022]
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Krasemann T. Aristotle score for "hybrid procedure". Pediatr Cardiol 2015; 36:454-5. [PMID: 25480353 DOI: 10.1007/s00246-014-1076-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/20/2014] [Accepted: 12/01/2014] [Indexed: 10/24/2022]
Affiliation(s)
- Thomas Krasemann
- Department of Paediatric Cardiology, Evelina London Children's Hospital, Westminster Bridge Road, London, SE1 7EH, UK,
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Karamlou T, Overman D, Hill KD, Wallace A, Pasquali SK, Jacobs JP, Jacobs ML, Caldarone CA. Stage 1 hybrid palliation for hypoplastic left heart syndrome--assessment of contemporary patterns of use: an analysis of The Society of Thoracic Surgeons Congenital Heart Surgery Database. J Thorac Cardiovasc Surg 2015; 149:195-201, 202.e1. [PMID: 25266878 PMCID: PMC4527867 DOI: 10.1016/j.jtcvs.2014.08.020] [Citation(s) in RCA: 72] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/09/2014] [Revised: 08/05/2014] [Accepted: 08/11/2014] [Indexed: 11/28/2022]
Abstract
OBJECTIVE Hybrid palliation is an alternative to Norwood stage 1 for the initial management of hypoplastic left heart syndrome. Contemporary multicenter hybrid use and institutional/patient factors associated with hybrid use relative to the Norwood have not been evaluated. We describe hybrid use in relation to institutional volume, patient factors, and short-term outcomes. METHODS Infants aged 60 days or less listed in The Society of Thoracic Surgeons Congenital Heart Surgery Database (2010-2012) undergoing initial palliation of hypoplastic left heart syndrome were included. Annual institutional hybrid use rates were calculated: [hybrid procedures/(Norwood + hybrid + transplant procedures)]. In-hospital outcomes for primary hybrid and primary Norwood were compared and stratified by high (defined as ≥50%) versus low (defined as ≤10%) institutional hybrid use. RESULTS Of 1728 patients (100 centers), most (n = 1496, 87%) underwent an index Norwood; 232 patients (13%) underwent an index hybrid procedure. Preoperative patient risk factors were more prevalent in patients undergoing the hybrid procedure. Only 13 of 100 institutions were high hybrid users, and these tended to have lower annual hypoplastic left heart syndrome index case volume. Unadjusted in-hospital mortality was higher for the hybrid compared with the Norwood procedure (30% vs 16%; P < .001). In-hospital mortality for the hybrid procedure was not associated with hybrid use (26% among institutions with low use vs 28% among institutions with high use). However, centers with high hybrid use had higher mortality after the Norwood (43%) compared with centers with low hybrid use (16%). CONCLUSIONS Few centers currently select the hybrid procedure for most infants with hypoplastic left heart syndrome. Although unadjusted in-hospital hybrid mortality is higher than Norwood mortality, potential risk factors are more prevalent among hybrid cases. Institutions with higher hybrid use have lower hypoplastic left heart syndrome case volume and higher Norwood mortality.
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Affiliation(s)
- Tara Karamlou
- Division of Pediatric Cardiac Surgery, Benioff Children's Hospital, University of California San Francisco, San Francisco, Calif.
| | - David Overman
- Division of Cardiovascular Surgery, The Children's Heart Clinic, Children's Hospitals and Clinics of Minnesota, Minneapolis, Minn
| | - Kevin D Hill
- Division of Pediatric Cardiology, Duke University Medical Center, Durham, NC
| | - Amelia Wallace
- Outcomes Research and Assessment Group, Duke Clinical Research Institute, Durham, NC
| | - Sara K Pasquali
- Department of Pediatrics, University of Michigan C. S. Mott Children's Hospital, Ann Arbor, Mich
| | - Jeffrey P Jacobs
- Division of Cardiac Surgery, Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Md
| | - Marshall L Jacobs
- Department of Surgery, Johns Hopkins School of Medicine, Baltimore, Md
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Corno AF. "Functionally" univentricular hearts: impact of pre-natal diagnosis. Front Pediatr 2015; 3:15. [PMID: 25774365 PMCID: PMC4343004 DOI: 10.3389/fped.2015.00015] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/12/2014] [Accepted: 02/16/2015] [Indexed: 01/08/2023] Open
Abstract
Within the last few decades the pre-natal echocardiographic diagnosis of congenital heart defects has made substantial progresses, particularly for the identification of complex malformation. "Functionally" univentricular hearts categorize a huge variety of heart malformations. Since no one of the patients with these congenital heart defects can ever undergo a bi-ventricular type of repair, early recognition and decision-making from the neonatal period are required in order to allow for appropriate multiple-step diagnostic and treatment procedures, either of interventional cardiology and/or surgery, on the pathway of "univentricular" heart. In the literature strong disagreements exist about the potential impact of the pre-natal diagnosis on the early and late outcomes of complex congenital heart defects. This review of the recent reports has been undertaken to better understand the impact of pre-natal diagnosis in "functionally" univentricular hearts taking into consideration the following topics: pre-natal screening, outcomes and survival, general morbidity, neurologic and developmental consequences, pregnancy management and delivery planning, resources utilization and costs/benefits issues, ethical implications, parents counseling, and interruption of pregnancy versus treatment.
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