Advertisement

Hybrid versus Norwood procedure for hypoplastic left heart syndrome: Contemporary series from a single center

Published:February 28, 2014DOI:https://doi.org/10.1016/j.jtcvs.2014.02.066

      Objective

      Two different strategies have emerged in the initial palliation for hypoplastic left heart syndrome, the conventional Norwood operation and the so-called hybrid procedure. We have used each of these at our center. The purpose of the present study was to compare the outcomes of both procedures.

      Methods

      From 2007 to 2012, 40 patients presented to the Cardinal Glennon Children's Medical Center with hypoplastic left heart syndrome or 1 of its variants. Of the 40 patients, 24 underwent a hybrid procedure and 16 a Norwood procedure for initial palliation. The medical records, echocardiograms, and cardiac catheterization data were retrospectively reviewed. Standard statistical analysis was performed.

      Results

      The patients who underwent the hybrid procedure weighed less than those who underwent the Norwood procedure. Overall unadjusted survival was better in the Norwood group, although this did not reach statistical significance. Overall hospital resource usage was similar in both cohorts, taking into account both first and second palliation stages.

      Conclusions

      In our review, we found no statistically significant difference in survival or resource usage between those patients undergoing the Norwood procedure and those undergoing a hybrid procedure as initial palliation for hypoplastic left heart syndrome.

      CTSNet classification

      Abbreviations and Acronyms:

      HLHS (hypoplastic left heart syndrome), SIP (stage I palliation), SIIP (stage II palliation)
      To read this article in full you will need to make a payment

      References

        • Tabbutt S.
        • Ghanayem N.
        • Ravishankar C.
        • Sleeper L.A.
        • Cooper D.S.
        • Frank D.U.
        • et al.
        Risk factors for hospital morbidity and mortality after the Norwood procedure: a report from the Pediatric Heart Network Single Ventricle Reconstruction trial.
        J Thorac Cardiovasc Surg. 2012; 144: 882-895
        • Tabbutt S.
        • Dominguez T.E.
        • Ravishankar C.
        • Marino B.S.
        • Gruber P.J.
        • Wernovsky G.
        • et al.
        Outcomes after the stage I reconstruction comparing the right ventricular to pulmonary artery conduit with the modified Blalock Taussig shunt.
        Ann Thorac Surg. 2005; 80: 1582-1590
        • Bacha E.A.
        • Daves S.
        • Hardin J.
        • Abdulla R.I.
        • Anderson J.
        • Kahana M.
        • et al.
        Single-ventricle palliation for high-risk neonates: the emergence of an alternative hybrid stage I strategy.
        J Thorac Cardiovasc Surg. 2006; 131: 163-171
        • Zoghbi W.A.
        • Enriquez-Sarano M.
        • Foster E.
        • Grayburn P.A.
        • Kraft C.D.
        • Levine R.A.
        • et al.
        Recommendations for evaluation of the severity of native valvular regurgitation with two-dimensional and Doppler echocardiography.
        J Am Soc Echocardiogr. 2003; 16: 777-802
        • Galantowicz M.
        • Cheatham J.P.
        • Phillips A.
        • Cua C.L.
        • Hoffman T.M.
        • Hill S.L.
        • et al.
        Hybrid approach for hypoplastic left heart syndrome: intermediate results after the learning curve.
        Ann Thorac Surg. 2008; 85: 1063-1071
        • Pizarro C.
        • Murdison K.A.
        • Derby C.D.
        • Radtke W.
        Stage II reconstruction after hybrid palliation for high-risk patients with a single ventricle.
        Ann Thorac Surg. 2008; 85: 1382-1388
        • Ghanayem N.S.
        • Hoffman G.M.
        • Mussatto K.A.
        • Cava J.R.
        • Frommelt P.C.
        • Rudd N.A.
        • et al.
        Home surveillance program prevents interstage mortality after the Norwood procedure.
        J Thorac Cardiovasc Surg. 2003; 126: 1367-1377
        • Venugopal P.S.
        • Luna K.P.
        • Anderson D.R.
        • Austin C.B.
        • Rosenthal E.
        • Krasemann T.
        • et al.
        Hybrid procedure as an alternative to surgical palliation of high-risk infants with hypoplastic left heart syndrome and its variants.
        J Thorac Cardiovasc Surg. 2010; 139: 1211-1215
        • Pizarro C.
        • Derby C.D.
        • Baffra J.M.
        • Murdison K.A.
        • Radtke W.A.
        Improving the outcome of high-risk neonates with hypoplastic left heart syndrome: hybrid procedure or conventional surgical palliation?.
        Eur J Cardiothorac Surg. 2008; 131: 412-417
        • Stasik C.N.
        • Gelehrter S.
        • Goldberg C.S.
        • Bove E.L.
        • Devaney E.J.
        • Ohve R.G.
        Current outcomes and risk factors for the Norwood procedure.
        J Thorac Cardiovas Surg. 2006; 131: 412-417
        • Photiadis J.
        • Sinzobahamvya N.
        • Haun C.
        • Schneider M.
        • Zartner P.
        • Schindler E.
        • et al.
        Does the shunt type determine mid-term outcome after Norwood operation?.
        Eur J Cardiothorac Surg. 2012; 42: 209-215
        • Weiss S.L.
        • Gossett J.G.
        • Kaushal S.
        • Wang D.
        • Backer C.L.
        • Wald E.L.
        Comparison of gastrointestinal morbidity after Norwood and hybrid palliation for complex heart defects.
        Pediatr Cardiol. 2011; 32: 391-398
        • Luce W.A.
        • Schwartz R.M.
        • Beauseau W.
        • Giannone P.J.
        • Boettner B.L.
        • Cheatham J.P.
        • et al.
        Necrotizing enterocolitis in neonates undergoing the hybrid approach to complex congenital heart disease.
        Pediatr Crit Care Med. 2011; 12: 46-51
        • Li J.
        • Zhang G.
        • Benson L.
        • Holtby H.
        • Cai S.
        • Humpl T.
        • et al.
        Comparison of the profiles of postoperative systemic hemodynamics and oxygen transport in neonates after the hybrid or the Norwood procedure: a pilot study.
        Circulation. 2007; 116: 179-187
        • Pilla C.B.
        • Pedra C.A.
        • Nogueira A.J.
        • Jatene M.
        • Souza L.C.
        • Pedra S.R.
        • et al.
        Hybrid management for hypoplastic left heart syndrome: an experience from Brazil.
        Pediatr Cardiol. 2008; 29: 498-506
        • Hansen J.H.
        • Runge U.
        • Uebing A.
        • Scheewe J.
        • Kramer H.H.
        • Fischer G.
        Cardiac catheterization and interventional procedures as part of staged surgical palliation for hypoplastic left heart syndrome.
        Congenit Heart Dis. 2012; 7: 565-574
        • Sakurai T.
        • Rogers V.
        • Stickley J.
        • Khan N.
        • Jones T.J.
        • Barron D.J.
        • et al.
        Single-center experience of arch reconstruction in the setting of Norwood operation.
        Ann Thorac Surg. 2012; 94: 1534-1539