Apples to oranges: Making sense of hybrid palliation for hypoplastic left heart syndrome

Wilder, Travis J.; Caldarone, Christopher A.

doi:10.1016/j.xjon.2020.10.002

Cited by 10 publications

(6 citation statements)

References 53 publications

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“…Nowadays, the Hybrid procedure is frequently used in critically ill HLHS patients with associated risk factors such as prematurity, low birth weight, and comorbidity with the opportunity for bridging to Norwood procedure or heart transplantation, later on ( 15 ). This has been classified as Norwood alternative, salvage procedure, deferred Norwood procedure, pre-transplantation palliation, or univentricular–biventricular decision deferral ( 16 ).…”

Section: Introductionmentioning

confidence: 99%

Neurodevelopmental and functional outcome in hypoplastic left heart syndrome after Hybrid procedure as stage I

Knirsch

Silvestro²,

Rhein³

2023

Front. Pediatr.

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BackgroundPatients with hypoplastic left heart syndrome (HLHS) undergoing staged palliation until Fontan procedure are at risk for impaired neurodevelopmental (ND) outcome. The Hybrid procedure with bilateral pulmonary artery banding, ductal stenting, and balloon atrioseptostomy may offer a less invasive stage I procedure compared to the Norwood stage I procedure avoiding early neonatal cardiopulmonary bypass (CPB) surgery. Despite altered fetal cerebral hemodynamics, the type of stage I procedure may be a covariate influencing ND outcome and functional outcome may also be altered due to postponing neonatal CPB surgery. Within this review, we analyzed ND outcome as well as functional outcome after Hybrid procedure as stage I procedure.MethodsThe review analyzed original publications (OPs) published before March 15, 2022, identified by Cochrane, EMBASE, OVID, Scopus, and Web of science. An OP was included if short-to-long-term neurodevelopment outcome, brain development, somatic, and cardiac outcome in patients for HLHS and variants treated by Hybrid procedure were analyzed. In addition to database searches, we reviewed all references of the analyzed OP to obtain a comprehensive list of available studies. The author, year of publication, demographic characteristics of study population, study design (prospective or retrospective), study assessment, and main findings were summarized.ResultsTwenty-one OPs were included with data of patients with ND outcome and functional cardiac outcome. Overall, there is an impaired mid-term ND outcome in patients with Hybrid procedure as stage I for HLHS. Only slight differences between stage I procedures (Hybrid vs. Norwood) in two comparing studies have been determined affecting right ventricular remodeling, short- and mid-term ND outcome, reduced brain growth until two years of age, sufficient quality of life, and altered hemodynamics influencing brain volumes and cerebral perfusion pattern.ConclusionsDespite some minor differences regarding the mid-term follow-up in patients with HLHS comparing Hybrid vs. Norwood procedure, its impact on ND outcome seems rather low. This may be explained by the large number of covariates as well as the small study populations and the different selection criteria for patients undergoing Hybrid or Norwood procedure as stage I.

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Section: Introductionmentioning

confidence: 99%

Neurodevelopmental and functional outcome in hypoplastic left heart syndrome after Hybrid procedure as stage I

Knirsch

Silvestro²,

Rhein³

2023

Front. Pediatr.

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show abstract

“…Indeed, the term "hybrid approach" is used as if oranges and apples are the same fruit. 1 In the event that stage I palliation with the hybrid approach for the newborn with HLHS should be more demanding than a Norwood procedure, 3 something seems to be wrong with the hybrid procedure, and Norwood surgery indeed should be preferred. 4 As the authors note, Gibbs and colleagues 5 developed the hybrid strategy in the early 1990s; however, the Leeds group abandoned this approach because the procedure failed, which is understandable.…”

Section: Hybrid Approach To Hypoplastic Left Heart Syndrome To the Edmentioning

confidence: 99%

Hybrid approach to hypoplastic left heart syndrome

Schranz

Akintuerk

2022

The Journal of Thoracic and Cardiovascular Surgery

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“…We appreciate the insightful response by Drs Schranz and Akintuerk to our hybrid review, 1 "Apples to Oranges: Making Sense of Hybrid Palliation for Hypoplastic Left Heart Syndrome." 2 Their pioneering work in using hybrid strategies for palliation of neonates with hypoplastic left heart syndrome (HLHS) and related variants has advanced the field of congenital heart surgery. It is not surprising, therefore, that they have added to the armamentarium of stage I palliation strategies by successfully treating 6 children using a total catheter-based approach (Figure 1).…”

Apples to oranges: Making sense of hybrid palliation for hypoplastic left heart syndrome

Cited by 10 publications

References 53 publications

Neurodevelopmental and functional outcome in hypoplastic left heart syndrome after Hybrid procedure as stage I

Neurodevelopmental and functional outcome in hypoplastic left heart syndrome after Hybrid procedure as stage I

Hybrid approach to hypoplastic left heart syndrome

Reply from authors: When is a hybrid no longer a hybrid?

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