title: Risk-stratified approach to hybrid transcatheter-surgical palliation of hypoplastic left heart syndrome.
abstract: We prospectively employed a risk-stratified approach to first-stage palliation of hypoplastic left heart syndrome. High-risk features included severe tricuspid insufficiency, severe right ventricular dysfunction, a severely restrictive or intact atrial septum, an ascending aortic diameter < or = 2 mm, late presentation, weight < 2 kg, or significant extracardiac issues, Infants without high-risk features underwent a Norwood procedure (with Sano modification), whereas infants with high-risk features underwent a hybrid procedure consisting of bilateral pulmonary artery banding, ductal stenting, and atrial septostomy or a Norwood/Sano. Operative survival for 10 infants without high-risk features undergoing a Norwood/Sano procedure was 90%. Operative survival for 5 infants with high-risk features undergoing hybrid palliation was 100%, compared to 29% in 7 infants with high-risk features undergoing the Norwood/Sano procedure. Although only short-term data are available, this hybrid palliative procedure may have a role for infants with hypoplastic left heart syndrome and high-risk features.
authors.affiliation: Children's Hospital Heart Center, Department of Pediatrics, University of Virginia, Charlottesville, P.O. Box 800386, VA, 22908-0386, USA. SL9PC@virginia.edu.
authors.forename: D S
authors.initials: DS
authors.lastname: Lim
authors.affiliation: Children's Hospital Heart Center, Department of Surgery, University of Virginia, Charlottesville, VA, 22908, USA.
authors.forename: B B
authors.initials: BB
authors.lastname: Peeler
authors.affiliation: Children's Hospital Heart Center, Department of Pediatrics, University of Virginia, Charlottesville, P.O. Box 800386, VA, 22908-0386, USA.
authors.forename: G P
authors.initials: GP
authors.lastname: Matherne
authors.affiliation: Children's Hospital Heart Center, Department of Surgery, University of Virginia, Charlottesville, VA, 22908, USA.
authors.forename: I L
authors.initials: IL
authors.lastname: Kron
authors.affiliation: Children's Hospital Heart Center, Department of Pediatrics, University of Virginia, Charlottesville, P.O. Box 800386, VA, 22908-0386, USA.
authors.forename: H P
authors.initials: HP
authors.lastname: Gutgesell
mesh_terms: D004374:Ductus Arteriosus, Patent / Q000601:surgery; D005260:Female; D005500:Follow-Up Studies; D006325:Heart Atria / Q000601:surgery; D006346:Heart Septum / Q000601:surgery; D017052:Hospital Mortality; D006801:Humans; D018636:Hypoplastic Left Heart Syndrome / Q000401:mortality / Q000601:surgery*; D007223:Infant; D007231:Infant, Newborn; D008168:Lung / Q000098:blood supply; D008297:Male; D010043:Outcome and Process Assessment, Health Care; D010100:Oxygen / Q000097:blood; D010166:Palliative Care / Q000379:methods*; D011446:Prospective Studies; D011651:Pulmonary Artery / Q000601:surgery; D018570:Risk Assessment / Q000379:methods*; D015607:Stents; D015996:Survival Rate; D014262:Tricuspid Valve Insufficiency / Q000401:mortality / Q000601:surgery; D018497:Ventricular Dysfunction, Right / Q000401:mortality / Q000601:surgery
chemical_list: D010100:Oxygen