Document Detail

Single-ventricle palliation for high-risk neonates: the emergence of an alternative hybrid stage I strategy.
MedLine Citation:
PMID:  16399308     Owner:  NLM     Status:  MEDLINE    
BACKGROUND: Survival after stage I palliation for hypoplastic left heart syndrome or related anomalies remains poor in high-risk neonates. We hypothesized that a less invasive hybrid approach would be beneficial in this patient population. METHODS: The hybrid stage I procedure was performed in the catheterization laboratory. Via a median sternotomy, both branch pulmonary arteries were banded, and a ductal stent was delivered via a main pulmonary artery puncture and positioned under fluoroscopic guidance. RESULTS: Between October 2003 and June 2005, 14 high-risk neonates underwent a hybrid stage I procedure. Eleven of 14 had hypoplastic left heart syndrome. Two also underwent peratrial atrial septal stenting, and 5 required percutaneous atrial stenting later. Two neonates with an intact or highly restrictive atrial septum had emergency percutaneous atrial stent placement. Hospital survival was 11 (78.5%) of 14. One patient required extracorporeal membrane oxygenation support for intraoperative cardiac arrest. He underwent cardiac transplantation but died later of sepsis. One patient died of ductal stent embolization, and a third died of progressive cardiac dysfunction. The first 4 patients required pulmonary artery band revisions. There were none after we modified our technique and added branch pulmonary artery angiograms. There were 2 interstage deaths from atrial stent occlusion and from preductal retrograde coarctation. Eight patients underwent stage II procedures, consisting of aortic arch reconstruction, atrial septectomy, and cavopulmonary shunt. Two patients died after stage II. One patient is awaiting stage II. CONCLUSIONS: The hybrid stage I palliation is a valid option in high-risk neonates. As experience is accrued, it may become the preferred alternative. However, in aortic atresia, the development of preductal retrograde coarctation is a significant problem.
Emile A Bacha; Suanne Daves; Joel Hardin; Ra-id Abdulla; Jennifer Anderson; Madelyn Kahana; Peter Koenig; Bassem N Mora; Mehmet Gulecyuz; Joanne P Starr; Ernerio Alboliras; Satinder Sandhu; Ziyad M Hijazi
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Publication Detail:
Type:  Journal Article     Date:  2005-12-05
Journal Detail:
Title:  The Journal of thoracic and cardiovascular surgery     Volume:  131     ISSN:  1097-685X     ISO Abbreviation:  J. Thorac. Cardiovasc. Surg.     Publication Date:  2006 Jan 
Date Detail:
Created Date:  2006-01-09     Completed Date:  2006-03-21     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  0376343     Medline TA:  J Thorac Cardiovasc Surg     Country:  United States    
Other Details:
Languages:  eng     Pagination:  163-171.e2     Citation Subset:  AIM; IM    
Department of Congenital and Pediatric Cardiac Surgery, The University of Chicago Children's Hospital, Chicago, Ill, USA.
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MeSH Terms
Cardiac Surgical Procedures / adverse effects,  methods
Hypoplastic Left Heart Syndrome / complications,  surgery*
Infant, Newborn
Postoperative Complications / epidemiology
Risk Factors

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