The hybrid approach for palliation of hypoplastic left heart syndrome: Intermediate results of a single-center experience

Abstract

Introduction: Hypoplastic left heart syndrome (HLHS) is a major cause of cardiac death during the first week of life. The hybrid approach is a reliable, reproducible treatment option for patients with HLHS. Herein we report our results using this approach, focusing on its efficacy, safety and late outcome. Methods: We reviewed prospectively collected data on patients treated for HLHS using a hybrid approach between July 2007 and September 2014. Results: Nine patients had a stage 1 hybrid procedure, with seven undergoing a comprehensive stage 2 procedure. One patient completed the Fontan procedure. Five patients underwent balloon atrial septostomy after the hybrid procedure; in three patients, a stent was placed across the atrial septum. There were three deaths: two early after the hybrid procedure and one early after stage two palliation. Overall survival was 66%. Conclusions: In our single-center series, the hybrid approach for HLHS yields intermediate results comparable to those of the Norwood strategy. The existence of dedicated teams for the diagnosis and management of these patients, preferably in high-volume centers, is of major importance in this condition.

Estenosis aórtica crítica y síndrome de corazón izquierdo hipoplásico de diagnóstico precoz en un hospital de segundo nivel

“…En nuestro caso el diagnóstico precoz de este tipo de patología demuestra que el entrenamiento en ecocardiografía fetal mejora las tasas de detección, lo que permite la derivación de los mismos a centros terciarios especializados donde puedan realizar terapias en pacientes seleccionados. En los últimos años la introducción del intervencionismo en patología cardíaca fetal, ha despertado un interés enorme por tratar de modificar la historia natural de esta enfermedad que permitan lograr una circulación biventricular y una cirugía correctora postnatal (10). La valvuloplastia intrauterina con balón aórtico (3) debe realizarse en pacientes seleccionados basándose en criterios cardiométricos (11) específicos, que pretenden determinar la situación hemodinámica fetal y la predicción de crecimiento y posible recuperación del ventrículo izquierdo disfuncionante.…”

Interstage somatic growth in children with hypoplastic left heart syndrome after initial palliation with the hybrid procedure

“…2 Nevertheless, its long-term impacts on child development remain uncertain, with only some intermediate results published at present. 2,6,7 Growth failure has received considerable attention as a potentially modifiable risk factor for increased morbidity, prolonged hospitalisation, and neurodevelopmental outcomes 8,9 in children with congenital heart disease (CHD). It is known to impact postoperative outcomes such as extended length of hospital stay 10 and risk of infection.…”