Hybrid strategy in neonates with ductal-dependent systemic circulation and multiple risk factors

Nicolle M. Ceneri, Division of Cardiac Surgery, Children's National Hospital, The George Washington University, School of Medicine and Health Sciences, Washington, DC.
Manan H. Desai, Division of Cardiac Surgery, Children's National Hospital, The George Washington University, School of Medicine and Health Sciences, Washington, DC.
Aybala Tongut, Division of Cardiac Surgery, Children's National Hospital, The George Washington University, School of Medicine and Health Sciences, Washington, DC.
Mahmut Ozturk, Division of Cardiac Surgery, Children's National Hospital, The George Washington University, School of Medicine and Health Sciences, Washington, DC.
Karthik Ramakrishnan, Division of Cardiac Surgery, Children's National Hospital, The George Washington University, School of Medicine and Health Sciences, Washington, DC.
Steven J. Staffa, Departments of Anesthesiology and Surgery, Boston Children's Hospital, Harvard Medical School, Boston, Mass.
David Zurakowski, Departments of Anesthesiology and Surgery, Boston Children's Hospital, Harvard Medical School, Boston, Mass.
Mary T. Donofrio, Division of Cardiology, Children's National Hospital, The George Washington University, School of Medicine and Health Sciences, Washington, DC.
Tacy Downing, Division of Cardiology, Children's National Hospital, The George Washington University, School of Medicine and Health Sciences, Washington, DC.
Yves d'Udekem, Division of Cardiac Surgery, Children's National Hospital, The George Washington University, School of Medicine and Health Sciences, Washington, DC.
Richard A. Jonas, Division of Cardiac Surgery, Children's National Hospital, The George Washington University, School of Medicine and Health Sciences, Washington, DC.
Can Yerebakan, Division of Cardiac Surgery, Children's National Hospital, The George Washington University, School of Medicine and Health Sciences, Washington, DC. Electronic address: cyerebakan@childrensnational.org.

Document Type

Journal Article

Publication Date

11-1-2022

Journal

The Journal of thoracic and cardiovascular surgery

Volume

164

Issue

5

DOI

10.1016/j.jtcvs.2021.11.103

Keywords

Norwood operation; hybrid; hypoplastic left heart syndrome; palliation; single ventricle

Abstract

OBJECTIVE: The study objective was to analyze outcomes of the hybrid strategy for ductal-dependent systemic circulation consisting of bilateral pulmonary artery banding with or without ductal stenting followed by delayed Norwood-type palliation or comprehensive stage II operation in high-risk neonates. METHODS: A retrospective analysis was performed between December 2017 and March 2021. Thirty high-risk neonates underwent palliation with bilateral pulmonary artery banding: 11 with prostaglandin therapy and 19 with ductal stenting. Median (range) age and body weight of patients at hybrid stage I were 3 days (0-43) and 2.9 kg (1.1-4.2), respectively. Operative and interstage mortality, morbidity, and reintervention rates were assessed. RESULTS: Overall survival was 70% (21/30) at a median follow-up time of 9 months (range, 0-37) from hybrid stage I. Operative survival for hybrid stage I was 90% (27/30), of which 2 patients received palliative care, and there was 1 interstage death (4%, 1/27). After hybrid stage I, 37% of patients had a reintervention, and 3% (n = 1) used extracorporeal membrane oxygenation before the next stage of repair. Five patients are awaiting second-stage operation, and 9 patients are awaiting Fontan completion. CONCLUSIONS: High-risk neonates with hypoplastic left heart syndrome or its variants can be successfully palliated using the hybrid strategy and bridged to a delayed Norwood or comprehensive stage II operation with satisfactory survival. This operative approach is a promising alternative pathway for neonates deemed to be high risk due to multiple preoperative risk factors.

Department

Pediatrics

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