Hybrid stage I palliation for hypo-plastic left heart condition without a hybrid suite: Suggestions for developing nations

Anuradha, S; Subramanyan, Raghavan; Agarwal, Ravi; Pezzella, A. Thomas; Cherian, K.M.

doi:10.1016/j.ihj.2012.05.001

Cited by 5 publications

(6 citation statements)

References 14 publications

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“…Another death occurred three months after completion of the first stage, secondary to decompensated cardiogenic shock due to a restrictive atrial septal defect, reflecting the difficulty of maintaining clinical follow-up continuity of our patients because of a lack of specialized professionals in the primary care network at our state. To minimize this matter, we have set up a specialized team for the treatment of complex pathologies [ 12 ] , since that there has been an increased number of cases referred to our care.…”

Section: Discussionmentioning

confidence: 99%

“…Among the patients studied, 50% already performed the second surgical stage, and 2 patients were not at the appropriate age and weight to perform this procedure. Because of the deaths occurred, we have tried to keep the continuous monitoring, monthly, which was only possible after assembling a specialized multidisciplinary team, as suggested by Anuradha et al [ 12 ] , to complement the assistance given to people in the public health care network.…”

Section: Discussionmentioning

confidence: 99%

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Modified Hybrid Procedure in Hypoplastic Left Heart Syndrome: Initial Experience of a Center in Northeastern Brazil

Faria¹,

Pacheco

Oliveira

et al. 2017

Braz J Cardiovasc Surg

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IntroductionAlthough it only corresponds to 2.5% of congenital heart defects, hypoplastic left heart syndrome (HLHS) is responsible for more than 25% of cardiac deaths in the first week of life. Palliative surgery performed after the second week of life is considered an important risk factor in the treatment of HLHS.ObjectiveThe aim of this study is to describe the initial experience of a medical center in Northeastern Brazil with a modified off-pump hybrid approach for palliation of HLHS.MethodsFrom November 2012 through November 2015, the medical records of 8 patients with HLHS undergoing hybrid procedure were retrospectively evaluated in a tertiary private hospital in Northeastern Brazil. The modified off-pump hybrid palliation consisted of stenting of the ductus arteriosus guided by fluoroscopy without contrast and banding of the main pulmonary artery branches. Demographic and clinical variables were recorded for descriptive analysis.ResultsEight patients were included in this study, of whom 37.5% were female. The median age and weight at the time of the procedure was 2 days (p25% and p75% = 2 and 4.5 days, respectively) and 3150 g (p25% and p75% = 3077.5 g and 3400 g, respectively), respectively. The median length in intensive care unit stay was 6 days (p25% and p75% = 3.5% and 8 days, respectively). There were no in-hospital deaths. Four patients have undergone to the second stage of the surgical treatment of HLHS.ConclusionIn this series, the initial experience with the modified off-pump hybrid procedure showed to be safe, allowing a low early mortality rate among children presenting HLHS.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Modified Hybrid Procedure in Hypoplastic Left Heart Syndrome: Initial Experience of a Center in Northeastern Brazil

Faria¹,

Pacheco

Oliveira

et al. 2017

Braz J Cardiovasc Surg

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“…Others have safely performed the hybrid stage I palliation for a hypoplastic left heart condition (aortic atresia with ventricular septal defect) in a two-month-old infant using minimal resources in a conventional catheterization laboratory. 15…”

Section: Hybrid Stage 1 Palliationmentioning

confidence: 99%

Management of Hypoplastic Left Heart Syndrome in Low-Resource Settings and the Ethics of Decision-Making

Edwin

Palacios-Macedo

et al. 2022

World J Pediatr Congenit Heart Surg

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Hypoplastic left heart syndrome (HLHS) is possibly the most challenging congenital heart defect to confront in any setting. The highly specialized infrastructure and resources needed to treat HLHS is not available in many low-resource settings. However, low-resource settings must not be assumed to be synonymous with low- and middle-income countries as national income is not necessarily indicative of a country’s prioritization of healthcare resources. Besides, a low-resource setting may be institution-specific as well as country-specific. We have stratified institutional capabilities for addressing the requirements of treatment for HLHS into five levels based on the capacity for diagnosis, intervention, and post-discharge monitoring. Depending on institutional capabilities, children born with HLHS in low-resource settings experience a spectrum of outcomes ranging from death without diagnosis to the hybrid or Norwood stage 1 palliation. The decision-making is ethically challenging when resources are scarce and economic efficiency must be considered in the context of distributive justice. Even in settings that would be classified as resource-rich where survival after surgery and quality of life afterward keep improving, not every parent would choose surgical intervention for their hypothetical child with HLHS.

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“…It has been suggested that the hybrid stage I is less costly, and can give more time to patients’ families in developing countries to arrange financial and medical support for the ulterior comprehensive stage I+II surgery. 36 Meticulous planning should be considered by all centers wanting to start programs to treat HLHS, which remains the most challenging of cardiac diagnoses to obtain consistent excellent outcomes in a sustainable fashion.…”

Section: Hypoplastic Left Heart Syndromementioning

confidence: 99%

Resource and cost considerations in treating hypoplastic left heart syndrome

Urencio¹,

Greenleaf²,

Salazar

et al. 2016

PHMT

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Hypoplastic left heart syndrome (HLHS) was a uniformly fatal diagnosis before 1983, when surgical treatment was first undertaken with the Norwood I operation as the first of 3-staged operations. Since then, operative survival rate of stage I has risen from 53% to over 90% in the current era, not only thanks to technical advances in surgery but also through prenatal diagnosis and imaging, enhanced cardiopulmonary bypass technology, better perioperative intensive care, and closer interstage monitoring. The improvements in patient outcomes achieved through rigorous multidisciplinary teamwork have come at a tremendous cost in manpower and resources, making HLHS still a challenge to all congenital heart programs, established or emerging. We review the various surgical steps to treat HLHS and their current expected outcomes, and put into perspective cost considerations compared to other more “simple” congenital heart defects.

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Hybrid stage I palliation for hypo-plastic left heart condition without a hybrid suite: Suggestions for developing nations

Cited by 5 publications

References 14 publications

Modified Hybrid Procedure in Hypoplastic Left Heart Syndrome: Initial Experience of a Center in Northeastern Brazil

Modified Hybrid Procedure in Hypoplastic Left Heart Syndrome: Initial Experience of a Center in Northeastern Brazil

Management of Hypoplastic Left Heart Syndrome in Low-Resource Settings and the Ethics of Decision-Making

Resource and cost considerations in treating hypoplastic left heart syndrome

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