Outcomes After Hybrid Palliation for Infants With Critical Left Heart Obstruction

被引:5
作者
Argo, Madison B. [1 ,2 ]
Barron, David J. [2 ]
Eghtesady, Pirooz [3 ]
Yerebakan, Can [4 ]
DeCampli, Williams M. [5 ]
Alsou, Bahaaldin [6 ]
Honjo, Osami [2 ]
Jacobs, Jeffrey P. [7 ]
Paramananthan, Tharini [2 ]
Rahman, Maha [2 ]
Lambert, Linda M. [8 ]
Jegatheeswaran, Anusha [9 ]
Carrillo, Sergio A. [10 ]
Husain, S. Adil [8 ]
Ramakrishnan, Karthik [11 ]
Caldarone, Christopher A. [12 ]
Karamlou, Tara [13 ,14 ]
Nelson, Jennifer [15 ]
Mannie, Chelsea [3 ]
Romano, Jennifer C. [16 ]
Turek, Joseph W. [17 ]
Blackstone, Eugene H. [13 ,14 ]
Galantowicz, Mark E. [10 ]
Kirklin, James K. [18 ]
Mitchell, Michael E. [19 ]
McCrindle, Brian W. [20 ]
机构
[1] Univ Wisconsin Hosp & Clin, Dept Surg, Madison, WI USA
[2] Hosp Sick Children, Div Cardiovasc Surg, Toronto, ON, Canada
[3] St Louis Childrens Hosp, Div Pediat Cardiothorac Surg, St Louis, MO USA
[4] Childrens Natl Hosp, Div Cardiac Surg, Washington, DC USA
[5] Arnold Palmer Hosp Children, Div Pediat Cardiac Surg, Orlando, FL USA
[6] Norton Childrens Hosp, Dept Cardiovasc & Thorac Surg, Louisville, KY USA
[7] Univ Florida, Div Cardiovasc Surg, Gainesville, FL USA
[8] Primary Childrens Med Ctr, Div Cardiothorac Surg, Salt Lake City, UT USA
[9] Great Ormond St Hosp Sick Children, Dept Cardiothorac Surg, London, England
[10] Nationwide Childrens Hosp, Dept Cardiothorac Surg, Columbus, OH USA
[11] LeBonheur Childrens Hosp, Div Pediat Cardiovasc Surg, Memphis, TN USA
[12] Texas Childrens Hosp, Div Congenital Heart Surg, Houston, TX USA
[13] Cleveland Clin, Dept Thorac & Cardiovasc Surg, Cleveland, OH USA
[14] Cleveland Clin, Heart Vasc & Thorac Inst, Cleveland, OH USA
[15] Childrens Mercy Kansas City, Div Pediat Cardiovasc Surg, Kansas City, MO USA
[16] Univ Michigan, Dept Cardiac Surg, Ann Arbor, MI USA
[17] Duke Childrens Hosp & Hlth Ctr, Dept Surg, Durham, NC USA
[18] Univ Alabama Birmingham, Div Cardiothorac Surg, Birmingham, AL USA
[19] Childrens Wisconsin, Div Pediat Cardiothorac Surg, Milwaukee, WI USA
[20] Hosp Sick Children, Div Pediat Cardiol, Toronto, ON, Canada
关键词
congenital heart disease; Fontan procedure; hypoplastic left heart syndrome; pulmonary artery banding; HYPOPLASTIC LEFT-HEART; STAGE; NORWOOD; HIGH-RISK; PULMONARY-ARTERIES; BIVENTRICULAR REPAIR; STRATEGIES; MORTALITY; SOCIETY; ECHOCARDIOGRAPHY; DUCT;
D O I
10.1016/j.jacc.2023.07.020
中图分类号
R5 [内科学];
学科分类号
1002 ; 100201 ;
摘要
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. None-theless, hybrid palliation may facilitate biventricular repair for some infants and for others may serve as stabilization for intended functional univentricular palliation or primary transplantation. (J Am Coll Cardiol 2023;82:1427-1441) (c) 2023 by the American College of Cardiology Foundation.
引用
收藏
页码:1427 / 1441
页数:15
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