Improving the outcome of high-risk neonates with hypoplastic left heart syndrome

hybrid procedure or conventional surgical palliation?

Christian Pizarro, Christopher D. Derby, Jeanne M. Baffa, Kenneth A Murdison, Wolfgang A. Radtke

Research output: Contribution to journalArticle

66 Citations (Scopus)

Abstract

Objectives: Despite significant progress, surgical outcome for high-risk patients with hypoplastic left heart syndrome (HLHS) remain suboptimal. The hybrid palliation lessens the initial operative insult and is expected to improve overall survival; however the outcome of this management sequence is unknown. Methods: Retrospective review of all high-risk neonates (prematurity, low birth weight, associated genetic or co-morbid conditions) undergoing initial palliation for HLHS either by hybrid or Stage I Norwood procedure at a single institution between January 2001 and December 2006. The two strategies were compared using survival after stage II as the end-point for outcome. Results: The cohort included 33 patients (14 hybrid and 19 Norwood) with a mean age of 3.8 ± 2.4 days, weight of 2.6 ± 0.6 kg and Aristotle comprehensive score of 18.7 ± 2.5. Aortic atresia was present in 5/14 hybrid and 12/19 Norwood patients. The mean gestational age was 36.8 ± 2.2 weeks, six patients were under 36 weeks in each group. Patients undergoing hybrid palliation had a lower preoperative pH [7.14 ± 0.2 vs 7.25 ± 0.05, p = 0.04], higher incidence of organ dysfunction [9/14 (64%) vs 5/19 (26%), p = 0.03] and less associated cardiac anomalies [3/13 (21%) vs 13/19 (68%), p = 0.009]. Hospital mortality and interstage mortality was 7/33 (21%) and 6/26 (23%) for the entire cohort, without significant differences between the hybrid and the conventional Norwood strategies. Of the original 33 patients only 16 (48.5%) were alive following the second stage procedure (7/14 (50%) hybrid and 9/19 (47.4%) Norwood). Conclusions: Regardless of the type of initial palliation, high-risk neonates with HLHS continue to have decreased survival. Although the hybrid approach reduces the initial surgical insult, important interstage mortality and ongoing morbidity result in survival no different than with conventional surgical palliation.

Original languageEnglish (US)
Pages (from-to)613-618
Number of pages6
JournalEuropean Journal of Cardio-thoracic Surgery
Volume33
Issue number4
DOIs
StatePublished - Apr 1 2008
Externally publishedYes

Fingerprint

Hypoplastic Left Heart Syndrome
Newborn Infant
Survival
Norwood Procedures
Mortality
Low Birth Weight Infant
Hospital Mortality
Gestational Age
Morbidity
Weights and Measures
Incidence

Keywords

  • CHD
  • CHD Fontan
  • CHD univentricular heart
  • Hypoplastic left heart syndrome
  • Pediatric
  • Surgery

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Surgery

Cite this

Improving the outcome of high-risk neonates with hypoplastic left heart syndrome : hybrid procedure or conventional surgical palliation? / Pizarro, Christian; Derby, Christopher D.; Baffa, Jeanne M.; Murdison, Kenneth A; Radtke, Wolfgang A.

In: European Journal of Cardio-thoracic Surgery, Vol. 33, No. 4, 01.04.2008, p. 613-618.

Research output: Contribution to journalArticle

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abstract = "Objectives: Despite significant progress, surgical outcome for high-risk patients with hypoplastic left heart syndrome (HLHS) remain suboptimal. The hybrid palliation lessens the initial operative insult and is expected to improve overall survival; however the outcome of this management sequence is unknown. Methods: Retrospective review of all high-risk neonates (prematurity, low birth weight, associated genetic or co-morbid conditions) undergoing initial palliation for HLHS either by hybrid or Stage I Norwood procedure at a single institution between January 2001 and December 2006. The two strategies were compared using survival after stage II as the end-point for outcome. Results: The cohort included 33 patients (14 hybrid and 19 Norwood) with a mean age of 3.8 ± 2.4 days, weight of 2.6 ± 0.6 kg and Aristotle comprehensive score of 18.7 ± 2.5. Aortic atresia was present in 5/14 hybrid and 12/19 Norwood patients. The mean gestational age was 36.8 ± 2.2 weeks, six patients were under 36 weeks in each group. Patients undergoing hybrid palliation had a lower preoperative pH [7.14 ± 0.2 vs 7.25 ± 0.05, p = 0.04], higher incidence of organ dysfunction [9/14 (64{\%}) vs 5/19 (26{\%}), p = 0.03] and less associated cardiac anomalies [3/13 (21{\%}) vs 13/19 (68{\%}), p = 0.009]. Hospital mortality and interstage mortality was 7/33 (21{\%}) and 6/26 (23{\%}) for the entire cohort, without significant differences between the hybrid and the conventional Norwood strategies. Of the original 33 patients only 16 (48.5{\%}) were alive following the second stage procedure (7/14 (50{\%}) hybrid and 9/19 (47.4{\%}) Norwood). Conclusions: Regardless of the type of initial palliation, high-risk neonates with HLHS continue to have decreased survival. Although the hybrid approach reduces the initial surgical insult, important interstage mortality and ongoing morbidity result in survival no different than with conventional surgical palliation.",
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T1 - Improving the outcome of high-risk neonates with hypoplastic left heart syndrome

T2 - hybrid procedure or conventional surgical palliation?

AU - Pizarro, Christian

AU - Derby, Christopher D.

AU - Baffa, Jeanne M.

AU - Murdison, Kenneth A

AU - Radtke, Wolfgang A.

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N2 - Objectives: Despite significant progress, surgical outcome for high-risk patients with hypoplastic left heart syndrome (HLHS) remain suboptimal. The hybrid palliation lessens the initial operative insult and is expected to improve overall survival; however the outcome of this management sequence is unknown. Methods: Retrospective review of all high-risk neonates (prematurity, low birth weight, associated genetic or co-morbid conditions) undergoing initial palliation for HLHS either by hybrid or Stage I Norwood procedure at a single institution between January 2001 and December 2006. The two strategies were compared using survival after stage II as the end-point for outcome. Results: The cohort included 33 patients (14 hybrid and 19 Norwood) with a mean age of 3.8 ± 2.4 days, weight of 2.6 ± 0.6 kg and Aristotle comprehensive score of 18.7 ± 2.5. Aortic atresia was present in 5/14 hybrid and 12/19 Norwood patients. The mean gestational age was 36.8 ± 2.2 weeks, six patients were under 36 weeks in each group. Patients undergoing hybrid palliation had a lower preoperative pH [7.14 ± 0.2 vs 7.25 ± 0.05, p = 0.04], higher incidence of organ dysfunction [9/14 (64%) vs 5/19 (26%), p = 0.03] and less associated cardiac anomalies [3/13 (21%) vs 13/19 (68%), p = 0.009]. Hospital mortality and interstage mortality was 7/33 (21%) and 6/26 (23%) for the entire cohort, without significant differences between the hybrid and the conventional Norwood strategies. Of the original 33 patients only 16 (48.5%) were alive following the second stage procedure (7/14 (50%) hybrid and 9/19 (47.4%) Norwood). Conclusions: Regardless of the type of initial palliation, high-risk neonates with HLHS continue to have decreased survival. Although the hybrid approach reduces the initial surgical insult, important interstage mortality and ongoing morbidity result in survival no different than with conventional surgical palliation.

AB - Objectives: Despite significant progress, surgical outcome for high-risk patients with hypoplastic left heart syndrome (HLHS) remain suboptimal. The hybrid palliation lessens the initial operative insult and is expected to improve overall survival; however the outcome of this management sequence is unknown. Methods: Retrospective review of all high-risk neonates (prematurity, low birth weight, associated genetic or co-morbid conditions) undergoing initial palliation for HLHS either by hybrid or Stage I Norwood procedure at a single institution between January 2001 and December 2006. The two strategies were compared using survival after stage II as the end-point for outcome. Results: The cohort included 33 patients (14 hybrid and 19 Norwood) with a mean age of 3.8 ± 2.4 days, weight of 2.6 ± 0.6 kg and Aristotle comprehensive score of 18.7 ± 2.5. Aortic atresia was present in 5/14 hybrid and 12/19 Norwood patients. The mean gestational age was 36.8 ± 2.2 weeks, six patients were under 36 weeks in each group. Patients undergoing hybrid palliation had a lower preoperative pH [7.14 ± 0.2 vs 7.25 ± 0.05, p = 0.04], higher incidence of organ dysfunction [9/14 (64%) vs 5/19 (26%), p = 0.03] and less associated cardiac anomalies [3/13 (21%) vs 13/19 (68%), p = 0.009]. Hospital mortality and interstage mortality was 7/33 (21%) and 6/26 (23%) for the entire cohort, without significant differences between the hybrid and the conventional Norwood strategies. Of the original 33 patients only 16 (48.5%) were alive following the second stage procedure (7/14 (50%) hybrid and 9/19 (47.4%) Norwood). Conclusions: Regardless of the type of initial palliation, high-risk neonates with HLHS continue to have decreased survival. Although the hybrid approach reduces the initial surgical insult, important interstage mortality and ongoing morbidity result in survival no different than with conventional surgical palliation.

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