Improving the outcome of high-risk neonates with hypoplastic left heart syndrome: hybrid procedure or conventional surgical palliation?

European Journal of Cardio-thoracic Surgery : Official Journal of the European Association for Cardio-thoracic Surgery
Christian PizarroWolfgang A Radtke

Abstract

Despite significant progress, surgical outcome for high-risk patients with hypoplastic left heart syndrome (HLHS) remain suboptimal. The hybrid palliation lessens the initial operative insult and is expected to improve overall survival; however the outcome of this management sequence is unknown. Retrospective review of all high-risk neonates (prematurity, low birth weight, associated genetic or co-morbid conditions) undergoing initial palliation for HLHS either by hybrid or Stage I Norwood procedure at a single institution between January 2001 and December 2006. The two strategies were compared using survival after stage II as the end-point for outcome. The cohort included 33 patients (14 hybrid and 19 Norwood) with a mean age of 3.8+/-2.4 days, weight of 2.6+/-0.6 kg and Aristotle comprehensive score of 18.7+/-2.5. Aortic atresia was present in 5/14 hybrid and 12/19 Norwood patients. The mean gestational age was 36.8+/-2.2 weeks, six patients were under 36 weeks in each group. Patients undergoing hybrid palliation had a lower preoperative pH [7.14+/-0.2 vs 7.25+/-0.05, p=0.04], higher incidence of organ dysfunction [9/14 (64%) vs 5/19 (26%), p=0.03] and less associated cardiac anomalies [3/13 (21%) vs 13/19 (68%), p=0.009]. Ho...Continue Reading

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