Combined Hybrid Procedure and VAD Insertion in 9 High-Risk Neonates and Infants With HLHS

Bleiweis, Mark S.; Philip, Joseph; Peek, Giles J.; Fudge, James C.; Sullivan, Kevin; Co-Vu, Jennifer; Gupta, Dipankar; Fricker, Frederick J.; Vyas, Himesh V.; Ebraheem, Mohammad; Powers, Emma; Falasa, Matheus P.; Jacobs, Jeffrey P.

doi:10.1016/j.athoracsur.2021.05.073

Cited by 18 publications

(29 citation statements)

References 30 publications

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“…Our rationale for this approach is that this current analysis allows assessment of all 83 patients with HLHS or HLHSrelated malformations who underwent evaluation for initial surgery at our institution from 2015 to 2021, inclusive, and therefore allows for complete assessment and analysis of our comprehensive approach to the management of these challenging patients. Furthermore, although our surgical techniques and protocols for anticoagulation have been previously reported, 6,7 the overall outcomes of this entire cohort have not been published until this current study.…”

Section: Prior Publicationsmentioning

confidence: 99%

“…In 2020, one additional infant with HLHS was supported with our HYBRID + VAD approach; although we previously reported this infant in a prior publication of our HYBRID + VAD approach, 6 we did not include this infant in this current analysis of 83 neonates and infants with HLHS and HLHS-related malformations undergoing initial palliation at our institution because this patient underwent initial surgical palliation at another institution. This patient had the diagnosis of HLHS with aortic atresia and mitral atresia along with severe pulmonary venous obstruction, cor triatriatum, and restrictive atrial septum.…”

Section: Study Populationmentioning

confidence: 99%

“…We previously reported our initial experience with 9 patients with HLHS bridged to cardiac transplantation with combined pulsatile ventricular assist device (VAD) insertion (Berlin EXCOR, Berlin Heart, Inc, Berlin, Germany) and Stage 1 hybrid palliation, consisting of application of bilateral pulmonary bands, stent placement in the patent arterial duct, and atrial septectomy if needed. 6,7 The purpose of this study is to describe our comprehensive approach to the management of patients with HLHS and HLHS-related malformations, and therefore, to report our entire current single center experience with 83 consecutive neonates and infants managed with this approach between 2015 and 2021, inclusive.…”

Section: Introductionmentioning

confidence: 99%

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A Comprehensive Approach to the Management of Patients With HLHS and Related Malformations: An Analysis of 83 Patients (2015-2021)

Bleiweis

Peek

Philip

et al. 2022

World J Pediatr Congenit Heart Surg

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Background: Some patients with hypoplastic left heart syndrome (HLHS) and HLHS-related malformations with ductal-dependent systemic circulation are extremely high-risk for Norwood palliation. We report our comprehensive approach to the management of these patients designed to maximize survival and optimize the utilization of donor hearts. Methods: We reviewed our entire current single center experience with 83 neonates and infants with HLHS and HLHS-related malformations (2015-2021). Standard-risk patients (n = 62) underwent initial Norwood (Stage 1) palliation. High-risk patients with risk factors other than major cardiac risk factors (n = 9) underwent initial Hybrid Stage 1 palliation, consisting of application of bilateral pulmonary bands, stent placement in the patent arterial duct, and atrial septectomy if needed. High-risk patients with major cardiac risk factors (n = 9) were bridged to transplantation with initial combined Hybrid Stage 1 palliation and pulsatile ventricular assist device (VAD) insertion (HYBRID + VAD). Three patients were bridged to transplantation with prostaglandin. Results: Overall survival at 1 year = 90.4% (75/83). Operative Mortality for standard-risk patients undergoing initial Norwood (Stage 1) Operation was 2/62 (3.2%). Of 60 survivors: 57 underwent Glenn, 2 underwent biventricular repair, and 1 underwent cardiac transplantation. Operative Mortality for high-risk patients with risk factors other than major cardiac risk factors undergoing initial Hybrid Stage 1 palliation without VAD was 0/9: 4 underwent transplantation, 1 awaits transplantation, 3 underwent Comprehensive Stage 2 (with 1 death), and 1 underwent biventricular repair. Of 9 HYBRID + VAD patients, 6 (67%) underwent successful cardiac transplantation and are alive today and 3 (33%) died while awaiting transplantation on VAD. Median length of VAD support was 134 days (mean = 134, range = 56-226). Conclusion: A comprehensive approach to the management of patients with HLHS or HLHS-related malformations is associated with Operative Mortality after Norwood of 2/62 = 3.2% and a one-year survival of 75/83 = 90.4%. A subset of 9/83 patients (11%) were stabilized with HYBRID + VAD while awaiting transplantation. VAD facilitates survival on the waiting list during prolonged wait times.

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Section: Prior Publicationsmentioning

confidence: 99%

Section: Study Populationmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

A Comprehensive Approach to the Management of Patients With HLHS and Related Malformations: An Analysis of 83 Patients (2015-2021)

Bleiweis

Peek

Philip

et al. 2022

World J Pediatr Congenit Heart Surg

Self Cite

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show abstract

“…Because of these potentially long waiting times, it is also reasonable to stabilize these high-risk patients with functionally univentricular hearts with Palliation + VAD while awaiting transplantation. 1 , 2 , 3 This approach facilitates early extubation and optimization for transplantation while on VAD in this high-risk population.…”

Section: Discussionmentioning

confidence: 99%

“…We have developed a comprehensive strategy for the management of neonates and infants with functionally univentricular hearts that includes the selective use of conventional neonatal palliation in standard-risk patients, hybrid approaches in neonates with elevated risk secondary to noncardiac etiology, and neonatal palliation combined with insertion of a single ventricular assist device (VAD) in neonates with elevated risk secondary to cardiac etiology ( Figures 1 and 2 ). 1 , 2 , 3 , 4 , 5 Our unique strategy has resulted in improved survival of children with functionally univentricular circulation. In this report, we describe our selection criteria, technical details, management strategies, pitfalls, and current outcomes for neonates with functionally univentricular hearts supported with VAD.…”

mentioning

confidence: 99%