Hybrid Palliation for Ductal-Dependent Systemic Circulation

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.

Stage-1 Hybrid Palliation for High-Risk 2-Ventricle Patients with Ductal-Dependent Systemic Circulation in the Era of High Prenatal Detection

“…In contrast to hypoplastic left heart syndrome with severe aortic and mitral valve hypoplasia or atresia, 10 there were no significant hemodynamic issues resulting from restricted interatrial or retrograde aortic arch flow, as forward aortic and unrestricted mitral flow were present, other than the single patient with aortic atresia and ventricular septal defect, who did not develop retrograde aortic arch obstruction. Nevertheless, considerable alternative comorbidities were present, often resulting in additional noncardiac surgical procedures such as gastrostomy-tube placements and tracheostomy.…”

“…We previously reported stage-1 hybrid palliation mortality rates of 0%, 3%, and 18%, respectively, for high-risk 2 ventricles, low-risk hypoplastic left heart, and high-risk hypoplastic left heart patients. 10 This report details results from a larger cohort of high-risk, 2-ventricle patients with complex congenital heart disease and ductal-dependent systemic circulation.…”

Common arterial trunk in the era of high prenatal detection rates: Results of neonatal palliation and primary repair

“…In 2007, our center adopted the hybrid method for Stage-1 hypoplastic left heart palliation. 11 Shortly after initiating Stage-1 hybrid palliation for hypoplastic left heart, we began applying the method for high-risk two-ventricle patients. Our previous publication included 20 high-risk, two-ventricular patients with an overall 95% midterm survival.…”

“…Our previous publication included 20 high-risk, two-ventricular patients with an overall 95% midterm survival. 11 Stage-1 hybrid palliation includes bilateral pulmonary banding and placement of a ductus arteriosus stent for those with aortic arch obstruction. Most patients with a common arterial trunk do not have aortic arch obstruction; thus, high-risk common arterial trunks bilateral pulmonary banding suffices as palliation.…”

“…In 2007, our center adopted the hybrid method for Stage‐1 hypoplastic left heart palliation 11 . Shortly after initiating Stage‐1 hybrid palliation for hypoplastic left heart, we began applying the method for high‐risk two‐ventricle patients.…”