Hybrid palliation to promote growth of left ventricle and left ventricular outflow tract

Abstract

OBJECTIVES In patients with borderline left hearts or a severe left ventricular outflow tract (LVOT) obstruction, hybrid palliation can be used to stabilize the patient and postpone biventricular repair (BVR). In this study we analyzed growth of left-sided structures and outcomes of these patients. METHODS We conducted a retrospective cohort study including patients who received hybrid palliation between January 2010 and September 2023. Echo measurements were collected at hybrid palliation, BVR and last follow-up. Growth of left ventricular structures were analyzed. RESULTS In 38 patients hybrid palliation was used to promote growth of left ventricular structures. In total, 15 patients received a Ross-Konno/Yasui procedure while 23 patients received conventional BVR. In patients with a conventional BVR significant increase was found in left ventricular volume indexed by BSA (LVEDVi), z-score of aortic valve (AoV) and LVOT between hybrid palliation and BVR. Mitral valve Z-score did not increase significantly. After BVR until follow-up only increase of the AoV Z-scores and LVEDVi were found significant. Of all included patients (n = 38), additional surgical procedures were necessary in 8 patients during the interstage period and 15 patients after BVR. Additional catheter interventions were needed in 14 patients in the interstage period and 15 after BVR. Six patients died, no mortality in the conventional BVR group. CONCLUSIONS Hybrid palliation as part of a staged biventricular repair is a safe and effective initial step and promotes growth of left ventricular structures in patients with small left-sided heart structures. Close follow-up is mandatory because extra catheter or surgical interventions are frequently needed.