title: Initial counseling prior to palliation for hypoplastic left heart syndrome.
abstract: OBJECTIVE
  Multiple surgical approaches to the initial palliation of patients with hypoplastic left heart syndrome (HLHS) have been advocated throughout the years. We sought to examine what procedure, if any, is recommended for HLHS management in regard to physician preference, anatomical variations, and concomitant medical issues.
  
  
  METHODS
  A Web-based survey of pediatric cardiologist subscribed to PediHeart was conducted.
  
  
  METHODS
  The types of palliation recommended (Norwood palliation, Sano modification, hybrid palliation, primary cardiac transplantation, or hospice care) for patients with HLHS with anatomic or comorbid variants were queried. Counseling provided by the physicians to families was also documented as regards survival and outcomes.
  
  
  RESULTS
  Two hundred physicians (21% female) who averaged 12.3 years removed from training responded to the survey. US East Coast and Midwest respondents were more likely to recommend Norwood palliation (54% and 60%, respectively) and the US South and West respondents preferred Sano modification (73% and 82%, respectively). Norwood or Sano palliation was recommended over hospice care, hybrid palliation, or cardiac transplant for patients with an intact atrial septum (P < 0.05), moderate to severe tricuspid regurgitation (P < 0.05), or low birth weight defined as less than 2 kg (P < 0.05). Hospice was preferred in low-birth-weight infants over hybrid palliation or cardiac transplantation (P < 0.05). Hospice was recommended over any other palliation for premature infants (less than 30 weeks gestation), chromosomal abnormalities, or end-organ dysfunction (P < 0.05).
  
  
  CONCLUSIONS
  This survey demonstrates that different palliative options are primarily recommended by caretakers based upon institutional location and patient characteristics. Prospective comparative trials may force a rethinking of this approach over time.
authors.affiliation: Nationwide Children's Hospital and Research Institute, Columbus, Ohio 43205, USA. andrew.yates@nationwidechildrens.org
authors.forename: Andrew R
authors.initials: AR
authors.lastname: Yates
authors.forename: Timothy M
authors.initials: TM
authors.lastname: Hoffman
authors.forename: Bethany
authors.initials: B
authors.lastname: Boettner
authors.forename: Timothy F
authors.initials: TF
authors.lastname: Feltes
authors.forename: Clifford L
authors.initials: CL
authors.lastname: Cua
mesh_terms: D006348:Cardiac Surgical Procedures / Q000009:adverse effects / Q000401:mortality; D003376:Counseling; D005260:Female; D019538:Health Care Surveys; D054625:Healthcare Disparities; D017051:Hospice Care; D006801:Humans; D018636:Hypoplastic Left Heart Syndrome / Q000150:complications / Q000401:mortality / Q000601:surgery*; D020407:Internet; D008297:Male; D010166:Palliative Care; D018579:Patient Selection; D010818:Practice Patterns, Physicians'; D011300:Preoperative Care; D012111:Residence Characteristics; D018570:Risk Assessment; D012307:Risk Factors; D014481:United States