title: Analysis of preoperative condition and interstage mortality in Norwood and hybrid procedures for hypoplastic left heart syndrome using the Aristotle scoring system.
abstract: OBJECTIVE
  The 'hybrid procedure', consisting of surgical banding of the pulmonary arteries with intraoperative stenting of the arterial duct, was developed as primary palliation in hypoplastic left heart syndrome (HLHS), avoiding the risks of cardiopulmonary bypass. In many centres, it is reserved for low birth weight, premature or unstable neonates; however, its role in such high risk cases of HLHS has yet to be defined.
  
  
  METHODS
  The preoperative condition of all patients with HLHS who underwent either the hybrid or the Norwood procedure for HLHS between 2005-2011 was analysed retrospectively, using a modified comprehensive Aristotle score. We then compared operative, interstage and 1 year mortalities between the groups after Aristotle adjustment via Cox proportional hazards analyses.
  
  
  RESULTS
  Of 138 patients with HLHS, 27 had hybrid and 111 Norwood procedures. The hybrid group had significantly higher Aristotle scores (mean 4.1 vs 1.8; p<0.001); however, there was no significant difference in mortality at any stage. At 1 year, the overall unadjusted survival among Norwood and hybrid patients was 58.6% and 51.9%, respectively, yielding an Aristotle adjusted hazard ratio for mortality among hybrid patients of 1.09 (95% CI 0.56 to 2.11, p=0.80).
  
  
  CONCLUSIONS
  Applying a hybrid approach to high risk patients with HLHS produces a comparable early and interstage mortality risk to lower risk patients undergoing the Norwood procedure. Prospective studies are needed to establish whether the hybrid procedure is a viable alternative to the Norwood procedure in all HLHS patients in terms of both mortality and long term morbidity.
authors.affiliation: Evelina London Children's Hospital, Guy's & St Thomas NHS Foundation Trust, , London, UK.
authors.forename: David F A
authors.initials: DF
authors.lastname: Lloyd
authors.forename: Lindsay
authors.initials: L
authors.lastname: Cutler
authors.forename: Shane M
authors.initials: SM
authors.lastname: Tibby
authors.forename: Sunitha
authors.initials: S
authors.lastname: Vimalesvaran
authors.forename: Shakeel Ahmed
authors.initials: SA
authors.lastname: Qureshi
authors.forename: Eric
authors.initials: E
authors.lastname: Rosenthal
authors.forename: David
authors.initials: D
authors.lastname: Anderson
authors.forename: Conal
authors.initials: C
authors.lastname: Austin
authors.forename: Hannah
authors.initials: H
authors.lastname: Bellsham-Revell
authors.forename: Thomas
authors.initials: T
authors.lastname: Krasemann
mesh_terms: D004452:Echocardiography; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D018636:Hypoplastic Left Heart Syndrome / Q000175:diagnosis / Q000401:mortality / Q000601:surgery*; D007226:Infant Mortality / Q000639:trends; D007231:Infant, Newborn; D008297:Male; D058327:Norwood Procedures; D010166:Palliative Care / Q000379:methods*; D057234:Preoperative Period; D016016:Proportional Hazards Models; D011651:Pulmonary Artery / Q000601:surgery*; D012189:Retrospective Studies; D012307:Risk Factors; D012720:Severity of Illness Index; D015996:Survival Rate / Q000639:trends; D016896:Treatment Outcome; D006113:United Kingdom / Q000453:epidemiology
keywords: Congenital Heart Disease