TY - JOUR
T1 - Outcomes After Hybrid Palliation for Infants With Critical Left Heart Obstruction
AU - Congenital Heart Surgeons Society Critical Left Heart Obstruction Work Group
AU - Argo, Madison B.
AU - Barron, David J.
AU - Eghtesady, Pirooz
AU - Yerebakan, Can
AU - DeCampli, Williams M.
AU - Alsoufi, Bahaaldin
AU - Honjo, Osami
AU - Jacobs, Jeffrey P.
AU - Paramananthan, Tharini
AU - Rahman, Maha
AU - Lambert, Linda M.
AU - Jegatheeswaran, Anusha
AU - Carrillo, Sergio A.
AU - Husain, S. Adil
AU - Ramakrishnan, Karthik
AU - Caldarone, Christopher A.
AU - Karamlou, Tara
AU - Nelson, Jennifer
AU - Mannie, Chelsea
AU - Romano, Jennifer C.
AU - Turek, Joseph W.
AU - Blackstone, Eugene H.
AU - Galantowicz, Mark E.
AU - Kirklin, James K.
AU - Mitchell, Michael E.
AU - McCrindle, Brian W.
N1 - Publisher Copyright:
© 2023 American College of Cardiology Foundation
PY - 2023/10/3
Y1 - 2023/10/3
N2 - Background: Hybrid palliation (bilateral pulmonary artery banding with or without ductal stenting) is an initial management strategy for infants with critical left heart obstruction and serves as palliation until subsequent operations are pursued. Objectives: This study sought to determine patient characteristics and factors associated with subsequent outcomes for infants who underwent hybrid palliation. Methods: From 2005 to 2019, 214 of 1,236 prospectively enrolled infants within the Congenital Heart Surgeons’ Society's critical left heart obstruction cohort underwent hybrid palliation across 24 institutions. Multivariable hazard modeling with competing risk methodology was performed to determine risk and factors associated with outcomes of biventricular repair, Fontan procedure, transplantation, or death. Results: Preoperative comorbidities (eg, prematurity, low birth weight, genetic syndrome) were identified in 70% of infants (150 of 214). Median follow-up was 7 years, ranging up to 17 years. Overall 12-year survival was 55%. At 5 years after hybrid palliation, 9% had biventricular repair, 36% had Fontan procedure, 12% had transplantation, 35% died without surgical endpoints, and 8% were alive without an endpoint. Factors associated with transplantation were absence of ductal stent, older age, absent interatrial communication, smaller aortic root size, larger tricuspid valve area z-score, and larger left ventricular volume. Factors associated with death were low birth weight, concomitant genetic syndrome, cardiopulmonary bypass use during hybrid palliation, moderate to severe tricuspid valve regurgitation, and smaller ascending aortic size. Conclusions: Mortality remains high after hybrid palliation for infants with critical left heart obstruction. Nonetheless, hybrid palliation may facilitate biventricular repair for some infants and for others may serve as stabilization for intended functional univentricular palliation or primary transplantation.
AB - Background: Hybrid palliation (bilateral pulmonary artery banding with or without ductal stenting) is an initial management strategy for infants with critical left heart obstruction and serves as palliation until subsequent operations are pursued. Objectives: This study sought to determine patient characteristics and factors associated with subsequent outcomes for infants who underwent hybrid palliation. Methods: From 2005 to 2019, 214 of 1,236 prospectively enrolled infants within the Congenital Heart Surgeons’ Society's critical left heart obstruction cohort underwent hybrid palliation across 24 institutions. Multivariable hazard modeling with competing risk methodology was performed to determine risk and factors associated with outcomes of biventricular repair, Fontan procedure, transplantation, or death. Results: Preoperative comorbidities (eg, prematurity, low birth weight, genetic syndrome) were identified in 70% of infants (150 of 214). Median follow-up was 7 years, ranging up to 17 years. Overall 12-year survival was 55%. At 5 years after hybrid palliation, 9% had biventricular repair, 36% had Fontan procedure, 12% had transplantation, 35% died without surgical endpoints, and 8% were alive without an endpoint. Factors associated with transplantation were absence of ductal stent, older age, absent interatrial communication, smaller aortic root size, larger tricuspid valve area z-score, and larger left ventricular volume. Factors associated with death were low birth weight, concomitant genetic syndrome, cardiopulmonary bypass use during hybrid palliation, moderate to severe tricuspid valve regurgitation, and smaller ascending aortic size. Conclusions: Mortality remains high after hybrid palliation for infants with critical left heart obstruction. Nonetheless, hybrid palliation may facilitate biventricular repair for some infants and for others may serve as stabilization for intended functional univentricular palliation or primary transplantation.
KW - Fontan procedure
KW - congenital heart disease
KW - hypoplastic left heart syndrome
KW - pulmonary artery banding
UR - https://www.scopus.com/pages/publications/85171190387
U2 - 10.1016/j.jacc.2023.07.020
DO - 10.1016/j.jacc.2023.07.020
M3 - Article
C2 - 37758438
AN - SCOPUS:85171190387
SN - 0735-1097
VL - 82
SP - 1427
EP - 1441
JO - Journal of the American College of Cardiology
JF - Journal of the American College of Cardiology
IS - 14
ER -