Early and Midterm Outcomes in High-risk Single-ventricle Patients: Hybrid Vs Norwood Palliation

Sower, Christopher T.; Romano, Jennifer C.; Yu, Sunkyung; Lowery, Ray; Pasquali, Sara K.; Zampi, Jeffrey D.

doi:10.1016/j.athoracsur.2019.06.061

Cited by 25 publications

(14 citation statements)

References 20 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Our data show decreased odds of this combined outcome of death, not a candidate for stage 1 palliation, and heart transplant in patients treated with a Blalock-Taussig or Sano shunt in comparison to a hybrid procedure, in agreement with prior studies showing decreased survival following the hybrid procedure. [28][29][30] Limitations of our current study are multifold. First, inherent in this study are the limitations present in all retrospective chart reviews.…”

Section: Transplant Free Survival To Stagementioning

confidence: 89%

Increased interstage morbidity and mortality following stage 1 palliation in patients with genetic abnormalities

Pierick

Scholz

et al. 2022

Cardiol Young

View full text Add to dashboard Cite

Background: Hypoplastic left heart syndrome and single ventricle variants with aortic hypoplasia are commonly classified as severe forms of CHD. We hypothesised patients with these severe defects and reported genetic abnormalities have increased morbidity and mortality during the interstage period. Methods and Results: This was a retrospective review of the National Pediatric Cardiology Quality Improvement Collaborative Phase I registry. Three patient groups were identified: major syndromes, other genetic abnormalities, and no reported genetic abnormality. Tukey post hoc test was applied for pairwise group comparisons of length of stay, death, and combined outcome of death, not a candidate for stage 2 palliation, and heart transplant. Participating centres received a survey to establish genetic testing and reporting practices. Of the 2182 patients, 110 (5%) had major genetic syndromes, 126 (6%) had other genetic abnormalities, and 1946 (89%) had no genetic abnormality. Those with major genetic syndromes weighed less at birth and stage 1 palliation. Patients with no reported genetic abnormalities reached full oral feeds sooner and discharged earlier. The combined outcome of death, not a candidate for stage 2 palliation, and heart transplant was more common in those with major syndromes. Survey response was low (n = 23, 38%) with only 14 (61%) routinely performing and reporting genetic testing. Conclusions: Patients with genetic abnormalities experienced greater morbidity and mortality during the interstage period than those with no reported genetic abnormalities. Genetic testing and reporting practices vary significantly between participating centres.

show abstract

Section: Transplant Free Survival To Stagementioning

confidence: 89%

Increased interstage morbidity and mortality following stage 1 palliation in patients with genetic abnormalities

Pierick

Scholz

et al. 2022

Cardiol Young

View full text Add to dashboard Cite

show abstract

“…Staged repair of complex congenital heart defects in combination with interrupted aortic arch and ductus-dependent perfusion of the lower body using hybrid procedure (bilateral pulmonary artery banding plus stenting of the patent ductus arteriosus) depicts an alternative approach in high-risk cases aiming biventricular repair. Whereas there are several publications reporting survival and re-intervention rate after hybrid procedure in univentricular palliation [ 2 , 16 , 17 ]), the follow up in children with biventricular repair after hybrid procedure and the need of reinterventions after debanding is not reported in detail yet. Erek et al [ 18 ] published a case report of six children with different aortic arch pathology with left ventricular outflow obstruction and biventricular repair with follow up until hospital discharge.…”

Section: Discussionmentioning

confidence: 99%

Impact of hybrid procedure on pulmonary arterial dimensions and right ventricular load after biventricular repair

Uhl

Grieshaber

Arnold

et al. 2023

J Cardiothorac Surg

View full text Add to dashboard Cite

Background Hybrid procedure with ductal stenting and bilateral pulmonary banding offers a temporary approach in high-risk neonates with complex congenital heart defects aiming biventricular repair. This procedure may also have negative impact concerning post-banding pulmonary stenosis resulting in right ventricular pressure load. Methods Between 2010 and 2021 we identified 5 patients with interrupted aortic arch and complex congenital heart defect who underwent hybrid procedure and staged biventricular repair (“hybrid-group”). Other 7 cases with interrupted aortic arch were corrected in the neonatal phase without hybrid procedure (“nonhybrid-group”). Detailed intra- and extracardiac features and surgical procedures were documented as well as pulmonary interventions during follow up. Pulmonary vessel size was assessed by diameter of left and right pulmonary artery in absolute and indexed values. RV pressure was evaluated invasively via catheterization. Results Survival in cases with hybrid procedure and staged biventricular repair was 91% for a follow-up time of 40.7 months (95% CI 26–55 months) and 100% in the non-hybrid-group. Postoperative results concerning left ventricular function showed normal LV dimensions and systolic function without relevant stenosis on distal aortic arch. Hybrid procedure was associated with impaired local pulmonary arterial diameter after debanding resulting in increased right ventricular pressure and need for interventions (number intervention per patient: hybrid group 1.7 ± 0.95, non-hybrid group 0.17 ± 0.41; P 0.003). Conclusions Hybrid procedure in high-risk cases with interrupted aortic arch and staged biventricular repair shows good postoperative results with low perioperative mortality and normal left ventricular function. Due to potential risk of relevant pulmonary stenosis and right ventricular pressure load, follow up examinations must not only focus on left but also on the right heart. Graphical Abstract

show abstract

“…Among patients with complete PFR migration, mean pressure in the exposed upper PAs ranged from 24 to 50 mm Hg. Six patients with IAS/R-PFO exhibited significant LA hypertension (median, 16 mm Hg [IQR, [16][17][18][19][20][21][22][23][24][25][26]). In the overall cohort, patients with LA hypertension had elevated pulmonary vascular resistance compared with those with normal LA pressure (median, 3.5 iWU [IQR, 3.1-4.5] versus median, 1.8 iWU [IQR, 1.1-2.2], respectively; P=0.003).…”

Section: Follow-up Hemodynamics Target Surgery and Patient-level Outc...mentioning

confidence: 99%

Transcatheter Palliation With Pulmonary Artery Flow Restrictors in Neonates With Congenital Heart Disease: Feasibility, Outcomes, and Comparison With a Historical Hybrid Stage 1 Cohort

Sperotto,

Lang,

Nathan

et al. 2023

Circ: Cardiovascular Interventions

View full text Add to dashboard Cite

Background: Neonates with complex congenital heart disease and pulmonary overcirculation have been historically treated surgically. However, subcohorts may benefit from less invasive procedures. Data on transcatheter palliation are limited. Methods: We present our experience with pulmonary flow restrictors (PFRs) for palliation of neonates with congenital heart disease, including procedural feasibility, technical details, and outcomes. We then compared our subcohort of high-risk single ventricle neonates palliated with PFRs with a similar historical cohort who underwent a hybrid Stage 1. Cox regression was used to evaluate the association between palliation strategy and 6-month mortality. Results: From 2021 to 2023, 17 patients (median age, 4 days; interquartile range [IQR], 2–8; median weight, 2.5 kilograms [IQR, 2.1–3.3]) underwent a PFR procedure; 15 (88%) had single ventricle physiology; 15 (88%) were high-risk surgical candidates. All procedures were technically successful. At a median follow-up of 6.2 months (IQR, 4.0–10.8), 13 patients (76%) were successfully bridged to surgery (median time since PFR procedure, 2.6 months [IQR, 1.1–4.4]; median weight, 4.9 kilograms [IQR, 3.4–5.8]). Pulmonary arteries grew adequately for age, and devices were easily removed without complications. The all-cause mortality rate before target surgery was 24% (n=4). Compared with the historical hybrid stage 1 cohort (n=23), after adjustment for main confounding (age, weight, intact/severely restrictive atrial septum or left ventricle to coronary fistulae), the PFR procedure was associated with a significantly lower all-cause 6-month mortality risk (adjusted hazard ratio, 0.26 [95% CI, 0.08–0.82]). Conclusions: Transcatheter palliation with PFR is feasible, safe, and represents an effective strategy for bridging high-risk neonates with congenital heart disease to surgical palliation, complete repair, or transplant while allowing for clinical stabilization and somatic growth.

show abstract

Early and Midterm Outcomes in High-risk Single-ventricle Patients: Hybrid Vs Norwood Palliation

Cited by 25 publications

References 20 publications

Increased interstage morbidity and mortality following stage 1 palliation in patients with genetic abnormalities

Increased interstage morbidity and mortality following stage 1 palliation in patients with genetic abnormalities

Impact of hybrid procedure on pulmonary arterial dimensions and right ventricular load after biventricular repair

Transcatheter Palliation With Pulmonary Artery Flow Restrictors in Neonates With Congenital Heart Disease: Feasibility, Outcomes, and Comparison With a Historical Hybrid Stage 1 Cohort

Contact Info

Product

Resources

About