title: Fifteen-year single center experience with the "Giessen Hybrid" approach for hypoplastic left heart and variants: current strategies and outcomes.
abstract: Presented is a retrospective outcome study of a 15-year single institutional experience with a contemporary cohort of patients with hypoplastic left heart syndrome and complex that underwent a "Giessen Hybrid" stage I as initial palliation. Hybrid approach consisting of surgical bilateral pulmonary artery banding and percutaneous duct stenting with or without atrial septum manipulation was developed from a rescue approach to a first-line procedure. Comprehensive Aristotle score defined pre-operative condition. Fifteen-year follow-up mortality is reported as occurring within the staged univentricular palliation or before and after biventricular repair. Hybrid stage I was performed in 154 patients; 107 should be treated by single ventricle palliation, 33 by biventricular repair (BVR), 7 received heart transplantation, and 7 were treated by comfort care, respectively. Overall 34 children died. The Aristotle score (mean value 18.2 ± 3) classified for univentricular circulations in newborns did not have statistical impact on the outcome. Two patients died during stage I (1.2%), and the interstage I mortality was 6.7%, and stage II mortality 9%, respectively. Stage III was up to now performed in 57 patients without mortality. At 1 year, the overall unadjusted survival of HLHS and variants was 84% and following BVR 89%, respectively. The Fifteen-year survival rate for HLHS and variants was 77%, with no significant impact of birth weight of less than 2.5 kg. In conclusion, Hybrid stage I fulfilled the criteria of life-saving approach. In our institution, Hybrid procedure replaced Norwood-staged palliation with a considerable mid- and long-term survival rate. Considering interstage mortality close surveillance is mandatory.
authors.affiliation: Pediatric Heart Center, Justus-Liebig University, Feulgenstr. 12, 30385, Giessen, Germany, Dietmar.schranz@paediat.med.uni-giessen.de.
authors.forename: Dietmar
authors.initials: D
authors.lastname: Schranz
authors.forename: Anna
authors.initials: A
authors.lastname: Bauer
authors.forename: Bettina
authors.initials: B
authors.lastname: Reich
authors.forename: Blanka
authors.initials: B
authors.lastname: Steinbrenner
authors.forename: Sabine
authors.initials: S
authors.lastname: Recla
authors.forename: Dorle
authors.initials: D
authors.lastname: Schmidt
authors.forename: Christian
authors.initials: C
authors.lastname: Apitz
authors.forename: Josef
authors.initials: J
authors.lastname: Thul
authors.forename: Klaus
authors.initials: K
authors.lastname: Valeske
authors.forename: Jürgen
authors.initials: J
authors.lastname: Bauer
authors.forename: Matthias
authors.initials: M
authors.lastname: Müller
authors.forename: Christian
authors.initials: C
authors.lastname: Jux
authors.forename: Ina
authors.initials: I
authors.lastname: Michel-Behnke
authors.forename: Hakan
authors.initials: H
authors.lastname: Akintürk
mesh_terms: D006348:Cardiac Surgical Procedures / Q000379:methods*; D005260:Female; D006801:Humans; D018636:Hypoplastic Left Heart Syndrome / Q000601:surgery*; D008297:Male; D012189:Retrospective Studies; D016896:Treatment Outcome