Hypoplastic left heart syndrome: a novel surgical strategy for small-volume centres?
OBJECTIVE
We describe in a prospective study, a novel surgical technique for the management of hypoplastic left heart syndrome inspired by the hybrid Norwood approach.


METHODS
This new neonatal palliation comprises replacement of the patent ductus arteriosus (PDA) and aortic arch plasty with a pulmonary homograft associated with the banding of both pulmonary arteries and atrial septectomy, under cardiopulmonary bypass without aortic clamping and cardioplegia. Initial results led to tightening of the pulmonary artery band from 3.5 mm to 2.5 mm.


RESULTS
From July 2014 to May 2016, 15 patients were initially palliated (13 patients with aortic atresia/mitral atresia, 1 with double inlet right ventricle, 1 with tricuspid atresia) at a median age of 5 days (1-8 days) and a median weight of 3.0 kg (2.3-3.9 kg). All but 2 patients were discharged from the hospital: There was 1 early in-hospital death and 1 patient required hospitalization in the intensive care unit until stage 2. There were also 4 interstage deaths. Nine patients underwent Stage 2 and 1 patient is still waiting. Compared to the classic Norwood procedure, early mortality decreased significantly (43.3-6.7%; P  = 0.0074) and overall mortality before Stage 2 was halved (61.6-33.3%). Postoperative morbidity was also reduced.


CONCLUSIONS
This new surgical palliative approach to hypoplastic left heart syndrome, particularly useable technically, seems to combine the advantages of the hybrid procedure by avoiding cardiac ischaemia and ventriculotomy without the complications of PDA stenting and restrictive atrial septectomy. Although the mortality rate decreased significantly, it remains substantial in small-volume centres, especially in the interstage period.
Department of Pediatric Cardiac Surgery, University Paris Descartes and Necker Sick Children Hospital, Paris, France.
Margaux
M
Pontailler
Department of Pediatric Cardiac Surgery, University Paris Descartes and Necker Sick Children Hospital, Paris, France.
Régis
R
Gaudin
Department of Pediatric Cardiac Surgery, University Paris Descartes and Necker Sick Children Hospital, Paris, France.
Marien
M
Lenoir
Department of Pediatric Cardiac Surgery, University Paris Descartes and Necker Sick Children Hospital, Paris, France.
Ayman
A
Haydar
Department of Pediatric Cardiology, University Paris Descartes and Necker Sick Children Hospital, Paris, France.
Diala
D
Kraiche
Department of Pediatric Cardiology, University Paris Descartes and Necker Sick Children Hospital, Paris, France.
Damien
D
Bonnet
Department of Pediatric Cardiac Surgery, University Paris Descartes and Necker Sick Children Hospital, Paris, France.
Pascal
P
Vouhé
Department of Pediatric Cardiac Surgery, University Paris Descartes and Necker Sick Children Hospital, Paris, France.
Olivier
O
Raisky
D064591:Allografts / Q000601:surgery / Q000637:transplantation; D001013:Aorta, Thoracic / Q000601:surgery; D005260:Female; D006801:Humans; D018636:Hypoplastic Left Heart Syndrome / Q000401:mortality / Q000601:surgery*; D007231:Infant, Newborn; D008297:Male; D058327:Norwood Procedures / Q000009:adverse effects / Q000379:methods / Q000401:mortality / Q000706:statistics & numerical data; D011183:Postoperative Complications; D011446:Prospective Studies; D011651:Pulmonary Artery / Q000601:surgery / Q000637:transplantation
Hybrid Norwood procedure ; Hypoplastic left heart syndrome ; Norwood procedure ; Pulmonary artery banding; Pulmonary homograft 