Published in:
01-02-2006
Risk-Stratified Approach to Hybrid Transcatheter–Surgical Palliation of Hypoplastic Left Heart Syndrome
Authors:
D.S. Lim, B.B. Peeler, G.P. Matherne, I.L. Kron, H.P. Gutgesell
Published in:
Pediatric Cardiology
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Issue 1/2006
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Abstract
We prospectively employed a risk-stratified approach to first-stage palliation of hypoplastic left heart syndrome. High-risk features included severe tricuspid insufficiency, severe right ventricular dysfunction, a severely restrictive or intact atrial septum, an ascending aortic diameter ≤2 mm, late presentation, weight <2 kg, or significant extracardiac issues, Infants without high-risk features underwent a Norwood procedure (with Sano modification), whereas infants with high-risk features underwent a hybrid procedure consisting of bilateral pulmonary artery banding, ductal stenting, and atrial septostomy or a Norwood/Sano. Operative survival for 10 infants without high-risk features undergoing a Norwood/Sano procedure was 90%. Operative survival for 5 infants with high-risk features undergoing hybrid palliation was 100%, compared to 29% in 7 infants with high-risk features undergoing the Norwood/Sano procedure. Although only short-term data are available, this hybrid palliative procedure may have a role for infants with hypoplastic left heart syndrome and high-risk features.