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01-12-2016 | Original Article

Arrhythmias After Stage I Hybrid Palliation in Single-Ventricle Patients

Authors: Jeffrey Moore, Diane Paulus, Clifford L. Cua, Naomi J. Kertesz, Yongjie Miao, John P. Cheatham, Mark Galantowicz, Richard Fernandez

Published in: Pediatric Cardiology | Issue 8/2016

Abstract

The hybrid procedure is an alternative palliative strategy for patients with single-ventricle physiology. No data exist documenting the incidence of arrhythmias after the hybrid procedure. Goal of this study was to determine the incidence and type of arrhythmias in patients undergoing the hybrid procedure. A retrospective chart review was performed including all patients undergoing the hybrid procedure between January of 2010 through December of 2013. Sixty-five patients underwent the hybrid procedure during this time period (43 HLHS, 22 other). Average gestational age at admission was 37.7 weeks. Average age at time of procedure was 7.6 days. Five patients had documented arrhythmias (7.7 %). Four were supraventricular tachycardias, and 1 was a sinus bradycardia. One patient with arrhythmia died during hospitalization, and another patient with arrhythmia died during the interstage period. Hybrid palliation for patients with single-ventricle physiology has a low incidence of arrhythmias. In this cohort of patients, arrhythmias did not contribute to mortality. There was a trend toward association between arrhythmias and longer total length of hospital stay.

Gibbs JL, Wren C, Watterson KG, Hunter S, Hamilton JR (1993) Stenting of the arterial duct combined with banding of the pulmonary arteries and atrial septectomy or septostomy: a new approach to palliation for the hypoplastic left heart syndrome. Br Heart J 69(6):551–555CrossRefPubMedPubMedCentral

Lloyd DF, Cutler L, Tibby SM, Vimalesvaran S, Qureshi SA, Rosenthal E, Anderson D, Austin C, Bellsham-Revell H, Krasemann T (2014) Analysis of preoperative condition and interstage mortality in Norwood and hybrid procedures for hypoplastic left heart syndrome using the Aristotle scoring system. Heart 100(10):775–780. doi:10.1136/heartjnl-2013-304759 CrossRefPubMed

Brescia AA, Jureidini S, Danon S, Armbrecht E, Fiore AC, Huddleston CB Hybrid versus Norwood procedure for hypoplastic left heart syndrome: contemporary series from a single center. [1097-685X (Electronic)]

Baba K, Kotani Y, Chetan D, Chaturvedi RR, Lee K-J, Benson LN, Grosse-Wortmann L, Van Arsdell GS, Caldarone CA, Honjo O (2012) Hybrid versus norwood strategies for single-ventricle palliation. Circulation 126(11 suppl 1):S123–S131. doi:10.1161/circulationaha.111.084616 CrossRefPubMed

Malik S, Bird TM, Jaquiss RD, Morrow WR, Robbins JM (2015) Comparison of in-hospital and longer-term outcomes of hybrid and Norwood stage 1 palliation of hypoplastic left heart syndrome. J Thorac Cardiovasc Surg 150(3):474–480. doi:10.1016/j.jtcvs.2015.06.071 CrossRefPubMed

Galantowicz M (2013) In favor of the Hybrid Stage 1 as the initial palliation for hypoplastic left heart syndrome. Semin Thorac Cardiovasc Surg Pediatr Cardiac Surg Annu 16(1):62–64. doi:10.1053/j.pcsu.2013.01.005 CrossRef

Trivedi B, Smith PB, Barker PC, Jaggers J, Lodge AJ, Kanter RJ (2011) Arrhythmias in patients with hypoplastic left heart syndrome. Am Heart J 161(1):138–144. doi:10.1016/j.ahj.2010.09.027 CrossRefPubMedPubMedCentral

Hehir DA, Dominguez TE, Ballweg JA, Ravishankar C, Marino BS, Bird GL, Nicolson SC, Spray TL, Gaynor JW, Tabbutt S (2008) Risk factors for interstage death after stage 1 reconstruction of hypoplastic left heart syndrome and variants. J Thorac Cardiovasc Surg 136(1):94–99. doi:10.1016/j.jtcvs.2007.12.012 CrossRefPubMed

Davidson J, Tong S, Hancock H, Hauck A, da Cruz E, Kaufman J (2012) Prospective validation of the vasoactive-inotropic score and correlation to short-term outcomes in neonates and infants after cardiothoracic surgery. Intensive Care Med 38(7):1184–1190. doi:10.1007/s00134-012-2544-x CrossRefPubMedPubMedCentral

10.

Galantowicz M, Cheatham JP (2005) Lessons learned from the development of a new hybrid strategy for the management of hypoplastic left heart syndrome. Pediatr Cardiol 26(2):190–199. doi:10.1007/s00246-004-0962-4 CrossRef

11.

Gaies MG, Gurney JG, Yen AH, Napoli ML, Gajarski RJ, Ohye RG, Charpie JR, Hirsch JC (2010) Vasoactive-inotropic score as a predictor of morbidity and mortality in infants after cardiopulmonary bypass. Pediatr Crit Care Med 11(2):234–238. doi:10.1097/PCC.0b013e3181b806fc CrossRefPubMed

12.

McFerson MC, McCanta AC, Pan Z, Collins KK, Jaggers J, da Cruz EM, Kaufman J (2014) Tachyarrhythmias after the Norwood procedure: relationship and effect of vasoactive agents. Pediatr Cardiol 35(4):668–675. doi:10.1007/s00246-013-0836-8 CrossRefPubMed

13.

Brix-Christensen V (2001) The systemic inflammatory response after cardiac surgery with cardiopulmonary bypass in children. Acta Anaesthesiol Scand 45(6):671–679CrossRefPubMed

14.

De Hert S, Moerman A (2015) Myocardial injury and protection related to cardiopulmonary bypass. Best Pract Res Clin Anaesthesiol 29(2):137–149. doi:10.1016/j.bpa.2015.03.002 CrossRefPubMed

15.

Hoffman TM, Wernovsky G, Atz AM, Kulik TJ, Nelson DP, Chang AC, Bailey JM, Akbary A, Kocsis JF, Kaczmarek R, Spray TL, Wessel DL (2003) Efficacy and safety of milrinone in preventing low cardiac output syndrome in infants and children after corrective surgery for congenital heart disease. Circulation 107(7):996–1002CrossRefPubMed

16.

Wilhelm CM, Paulus D, Cua CL, Kertesz NJ, Cheatham JP, Galantowicz M, Fernandez RP (2015) Arrhythmias following comprehensive stage II surgical palliation in single ventricle patients. Pediatr Cardiol 14:14

17.

Orejarena LA, Vidaillet H Jr, DeStefano F, Nordstrom DL, Vierkant RA, Smith PN, Hayes JJ (1998) Paroxysmal supraventricular tachycardia in the general population. J Am Coll Cardiol 31(1):150–157CrossRefPubMed

18.

Tripathi A, Black GB, Park YM, Jerrell JM (2014) Factors associated with the occurrence and treatment of supraventricular tachycardia in a pediatric congenital heart disease cohort. Pediatr Cardiol 35(2):368–373CrossRefPubMed

19.

Baker CE, Corsini C, Cosentino D, Dubini G, Pennati G, Migliavacca F, Hsia TY, Modeling of Congenital Hearts Alliance I (2013) Effects of pulmonary artery banding and retrograde aortic arch obstruction on the hybrid palliation of hypoplastic left heart syndrome. J Thorac Cardiovasc Surg 146(6):1341–1348. doi:10.1016/j.jtcvs.2013.01.038 CrossRefPubMed

20.

Corsini C, Biglino G, Schievano S, Hsia TY, Migliavacca F, Pennati G, Taylor AM, Group MC (2014) The effect of modified Blalock-Taussig shunt size and coarctation severity on coronary perfusion after the Norwood operation. Ann Thorac Surg 98(2):648–654. doi:10.1016/j.athoracsur.2014.04.047 CrossRefPubMed

21.

Stoica SC, Philips AB, Egan M, Rodeman R, Chisolm J, Hill S, Cheatham JP, Galantowicz ME (2009) The retrograde aortic arch in the hybrid approach to hypoplastic left heart syndrome. Ann Thorac Surg 88(6): 1939–1946; Discussion 1946–1937. doi:10.1016/j.athoracsur.2009.06.115

22.

Mewhort HE, Haller C, Caldarone C (2015) Management of retrograde aortic arch malperfusion after hybrid stage I palliation for hypoplastic left heart syndrome. J Thorac Cardiovasc Surg. doi:10.1016/j.jtcvs.2015.05.064

23.

Cua CL, Thiagarajan RR, Taeed R, Hoffman TM, Lai L, Hayes J, Laussen PC, Feltes TF (2005) Improved interstage mortality with the modified Norwood procedure: a meta-analysis. Ann Thorac Surg 80(1):44–49. doi:10.1016/j.athoracsur.2005.01.059 CrossRefPubMed

24.

Donnelly JP, Raffel DM, Shulkin BL, Corbett JR, Bove EL, Mosca RS, Kulik TJ (1998) Resting coronary flow and coronary flow reserve in human infants after repair or palliation of congenital heart defects as measured by positron emission tomography. J Thorac Cardiovasc Surg 115(1):103–110CrossRefPubMed

25.

Raja SG, Atamanyuk I, Kostolny M, Tsang V (2010) In hypoplastic left heart patients is Sano shunt compared with modified Blalock-Taussig shunt associated with deleterious effects on ventricular performance? Interact CardioVasc Thorac Surg 10(4):620–623CrossRefPubMed

26.

Ghanayem NS, Allen KR, Tabbutt S, Atz AM, Clabby ML, Cooper DS, Eghtesady P, Frommelt PC, Gruber PJ, Hill KD, Kaltman JR, Laussen PC, Lewis AB, Lurito KJ, Minich LL, Ohye RG, Schonbeck JV, Schwartz SM, Singh RK, Goldberg CS (2012) Interstage mortality after the Norwood procedure: results of the multicenter single ventricle reconstruction trial. J Thorac Cardiovasc Surg 144(4):896–906. doi:10.1016/j.jtcvs.2012.05.020 CrossRefPubMedPubMedCentral

27.

Galantowicz M, Cheatham JP, Phillips A, Cua CL, Hoffman TM, Hill SL, Rodeman R (2008) Hybrid approach for hypoplastic left heart syndrome: intermediate results after the learning curve. Ann Thorac Surg 85(6): 2063–2070; Discussion 2070–2061. doi:10.1016/j.athoracsur.2008.02.009

28.

Ghanayem NS, Hoffman GM, Mussatto KA, Cava JR, Frommelt PC, Rudd NA, Steltzer MM, Bevandic SM, Frisbee SS, Jaquiss RD, Litwin SB, Tweddell JS (2003) Home surveillance program prevents interstage mortality after the Norwood procedure. J Thorac Cardiovasc Surg 126(5):1367–1377. doi:10.1016/S0022 CrossRefPubMed

29.

Siehr SL, Norris JK, Bushnell JA, Ramamoorthy C, Reddy VM, Hanley FL, Wright GE (2014) Home monitoring program reduces interstage mortality after the modified Norwood procedure. J Thorac Cardiovasc Surg 147(2):718–723. doi:10.1016/j.jtcvs.2013.04.006 CrossRefPubMed

Title: Arrhythmias After Stage I Hybrid Palliation in Single-Ventricle Patients
Authors: Jeffrey Moore
Diane Paulus
Clifford L. Cua
Naomi J. Kertesz
Yongjie Miao
John P. Cheatham
Mark Galantowicz
Richard Fernandez
Publication date: 01-12-2016
Publisher: Springer US
Published in: Pediatric Cardiology / Issue 8/2016
Print ISSN: 0172-0643
Electronic ISSN: 1432-1971
DOI: https://doi.org/10.1007/s00246-016-1450-3

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