title: Use of a pressure guidewire to assess pulmonary artery band adequacy in the hybrid stage I procedure for high-risk neonates with hypoplastic left heart syndrome and variants.
abstract: OBJECTIVE
  The hybrid stage I procedure is an alternative palliative strategy for patients with hypoplastic left heart syndrome who traditionally have undergone the Norwood operation. At our institution, the hybrid stage I procedure is employed only for patients with high operative risk. Our objective was to describe our use of a pressure guidewire during the hybrid stage I procedure to assess quantitatively pulmonary artery band adequacy.
  
  
  METHODS
  After reviewing the charts on all high-risk patients who underwent a hybrid stage I procedure at our institution, we compared two groups of patients: those who underwent the standard hybrid stage I palliation (standard cohort) and those with pressure wire-facilitated assessment of distal branch pulmonary artery pressure (pressure wire cohort) to evaluate the impact of pressure guidewire use on procedural risk, radiation time, patient outcomes, and need for reoperation for pulmonary artery band adjustment.
  
  
  RESULTS
  The pressure guidewire was used in 8 of 14 patients at the time of hybrid stage I procedure and was successful and without complication in all attempts. In the standard cohort, 67% of patients needed reoperation for pulmonary artery band adjustment, compared to 12.5% of patients in the pressure wire cohort (P =.09). Procedure time, radiation exposure, and survival to hospital discharge were not different between groups.
  
  
  CONCLUSIONS
  This novel use of a pressure guidewire to assess quantitatively pulmonary artery band adequacy at the time of placement is feasible, safe and may decrease the need for reoperation for pulmonary artery band adjustment.
authors.affiliation: Division of Pediatric Cardiology, Department of Pediatrics, University of Michigan, Ann Arbor, Mich, USA. jzampi@med.umich.edu
authors.forename: Jeffrey D
authors.initials: JD
authors.lastname: Zampi
authors.forename: Jennifer C
authors.initials: JC
authors.lastname: Hirsch
authors.forename: Bryan H
authors.initials: BH
authors.lastname: Goldstein
authors.forename: Aimee K
authors.initials: AK
authors.lastname: Armstrong
mesh_terms: D062186:Arterial Pressure; D062906:Cardiac Catheters; D006348:Cardiac Surgical Procedures / Q000009:adverse effects / Q000401:mortality; D002407:Catheterization, Swan-Ganz / Q000295:instrumentation*; D003250:Constriction; D004867:Equipment Design; D005240:Feasibility Studies; D006801:Humans; D018636:Hypoplastic Left Heart Syndrome / Q000175:diagnosis / Q000401:mortality / Q000503:physiopathology / Q000601:surgery*; D007231:Infant, Newborn; D010166:Palliative Care; D011183:Postoperative Complications / Q000601:surgery; D011237:Predictive Value of Tests; D011651:Pulmonary Artery / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000601:surgery*; D011829:Radiation Dosage; D015641:Radiography, Interventional; D012086:Reoperation; D012189:Retrospective Studies; D012307:Risk Factors; D013997:Time Factors; D014160:Transducers, Pressure; D016896:Treatment Outcome