Successful Hybrid Stage I Palliation for Hypoplastic Left Heart Syndrome in a Developing Nation

Cuaso, Charles C.; Cheng, Dexter D.; Rosario, Jonas D. Del; Plucena, Leah Patricia A.; Pasimio, Raquel; Reyes, Karl G.

doi:10.1177/2150135111424295

Cited by 3 publications

(3 citation statements)

References 5 publications

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“…These efforts have primarily focused on Norwood stage 1 surgery, demonstrating a 41% survival rate after the initial stage. A few instances of utilizing the hybrid stage 1 procedure are documented in the Philippines ( 20 ) and India ( 21 ).…”

Section: Discussionmentioning

confidence: 99%

Hybrid stage 1 palliation for HLHS: the experience of a tertiary center in a developing country

Bitar,

El-Rassi,

Zareef

et al. 2024

Front. Cardiovasc. Med.

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BackgroundHypoplastic left heart syndrome (HLHS) accounts for 2.6% of congenital heart disease and is an invariably fatal cardiac anomaly if left untreated. Approximately 33,750 babies are born annually with HLHS in developing countries. Unfortunately, the majority will not survive due to the scarcity of resources and the limited availability of surgical management.AimTo describe and analyze our experience with the hybrid approach in the management of HLHS in a developing country.MethodsWe performed a retrospective single-center study involving all neonates born with HLHS over five years at the Children's Heart Center at the American University of Beirut. The medical records of patients who underwent the hybrid stage 1 palliation were reviewed, and data related to baseline characteristics, procedure details and outcomes were collected to describe the experience at a tertiary care center in a developing country.ResultsA total of 18 patients were diagnosed with HLHS over a five-year period at our institution, with male to female ratio of 1:1. Of those, eight patients underwent the hybrid stage I procedure. The mean weight at the time of the procedure was 3.3 ± 0.3 kg with an average age of 6.4 ± 4 days. The mean hospital length of stay was 27.25 days, with an interquartile range of 33 days. The cohort's follow-up duration averaged 5.9 ± 3.5 years. The surgical mortality was zero. Only one mortality was recorded during the interstage period between stage I and II and was attributed to sepsis. Notably, all surviving patients maintained preserved and satisfactory cardiac function with good clinical status.ConclusionOur limited experience underscores the potential of developing countries with proper foundations to adopt the hybrid procedure for HLHS, yielding outcomes on par with those observed in developed countries. This demonstrates the viability of establishing a more balanced global landscape for children with congenital heart disease.

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Section: Discussionmentioning

confidence: 99%

Hybrid stage 1 palliation for HLHS: the experience of a tertiary center in a developing country

Bitar,

El-Rassi,

Zareef

et al. 2024

Front. Cardiovasc. Med.

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“…This approach was adopted by Cuaso and coworkers in the Philippines, a setting with limited success at performing the Norwood procedure. 13 The authors indicate that in the Philippines, multiple attempts at Norwood stage I palliation had been made with no previous survivors. Without prostaglandin for initial stabilization of ductal blood supply to the lungs and limited neonatal cardiopulmonary bypass experience, the hybrid approach was considered the best option for initial management of the patient.…”

Section: Outcome Of Neonates Born With Hlhs In Low-resource Settingsmentioning

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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“…1,2 There are very few reports of successful hybrid stage 1 palliation from developing nations because organizing such suites is expensive and difficult. 3 …”

Section: Introductionmentioning

confidence: 97%

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

Anuradha

Subramanyan

Agarwal

et al. 2012

Indian Heart Journal

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Cardiac hybrid procedures are performed in modern, spacious, and highly equipped hybrid suites in developed countries. Organizing such expensive suites in countries with an emerging economy is difficult from both a financial and logistics point of view. We share our experience of safely performing a Hybrid stage I palliation procedure for Aortic atresia with ventricular septal defect on a 2-month-old infant weighing 3.35 kg using minimal resources in a conventional catheterization laboratory.

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Successful Hybrid Stage I Palliation for Hypoplastic Left Heart Syndrome in a Developing Nation

Cited by 3 publications

References 5 publications

Hybrid stage 1 palliation for HLHS: the experience of a tertiary center in a developing country

Hybrid stage 1 palliation for HLHS: the experience of a tertiary center in a developing country

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

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

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