Abstract
Objective
The study objective was to analyze outcomes of the hybrid strategy for ductal-dependent
systemic circulation consisting of bilateral pulmonary artery banding with or without
ductal stenting followed by delayed Norwood-type palliation or comprehensive stage
II operation in high-risk neonates.
Methods
A retrospective analysis was performed between December 2017 and March 2021. Thirty
high-risk neonates underwent palliation with bilateral pulmonary artery banding: 11
with prostaglandin therapy and 19 with ductal stenting. Median (range) age and body
weight of patients at hybrid stage I were 3 days (0-43) and 2.9 kg (1.1-4.2), respectively.
Operative and interstage mortality, morbidity, and reintervention rates were assessed.
Results
Overall survival was 70% (21/30) at a median follow-up time of 9 months (range, 0-37)
from hybrid stage I. Operative survival for hybrid stage I was 90% (27/30), of which
2 patients received palliative care, and there was 1 interstage death (4%, 1/27).
After hybrid stage I, 37% of patients had a reintervention, and 3% (n = 1) used extracorporeal
membrane oxygenation before the next stage of repair. Five patients are awaiting second-stage
operation, and 9 patients are awaiting Fontan completion.
Conclusions
High-risk neonates with hypoplastic left heart syndrome or its variants can be successfully
palliated using the hybrid strategy and bridged to a delayed Norwood or comprehensive
stage II operation with satisfactory survival. This operative approach is a promising
alternative pathway for neonates deemed to be high risk due to multiple preoperative
risk factors.
Graphical abstract
Graphical Abstract
Key Words
Abbreviations and Acronyms:
BiV (biventricular), BDG (bidirectional Glenn), BPAB (bilateral pulmonary artery banding), CICU (cardiac intensive care unit), CSII (comprehensive stage II), ECMO (extracorporeal membrane oxygenation), HLHS (hypoplastic left heart syndrome), MRI (magnetic resonance imaging)To read this article in full you will need to make a payment
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Article info
Publication history
Published online: March 15, 2022
Accepted:
November 23,
2021
Received in revised form:
October 7,
2021
Received:
April 30,
2021
Footnotes
This study reports the results of a multidisciplinary program that required the involvement of investigators from multiple departments at our institution.
The Institutional Review Board of Children's National Hospital approved this study with a waiver of individual consent (Institutional Review Board #09933, 1/22/18).
Read at the 101st Annual Meeting of The American Association for Thoracic Surgery: A Virtual Learning Experience, April 30-May 2, 2021.
Identification
Copyright
© 2022 by The American Association for Thoracic Surgery
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Access this article on ScienceDirectLinked Article
- Notice of CorrectionThe Journal of Thoracic and Cardiovascular SurgeryVol. 165Issue 1
- PreviewRe: Ceneri NM, Desai MH, Tongut A, Ozturk M, Ramakrishnan K, Staffa SJ, et al; Children's National Hospital Hybrid Working Group. Hybrid strategy in neonates with ductal-dependent systemic circulation and multiple risk factors. J Thorac Cardiovasc Surg. 2022;164:1291-303. https://doi.org/10.1016/j.jtcvs.2021.11.103
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- Commentary: Palliation pit stopThe Journal of Thoracic and Cardiovascular SurgeryVol. 164Issue 5
- PreviewDespite improvements in surgical technique and medical care, 1-year transplant-free survival rates for newborns with hypoplastic left heart syndrome continue to approximate 70%.1 Bilateral pulmonary artery banding with ductal stenting (hybrid palliation) was initially developed to alter this paradigm by avoiding cardiopulmonary bypass and circulatory arrest in the neonatal period.2 Reported results for this strategy are either equivalent or inferior to Norwood.3 Most centers use the hybrid procedure selectively for high-risk patient populations.
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