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

Ceneri, Nicolle; Desai, Manan; Tongut, Aybala; Öztürk, Mahmut; Ramakrishnan, Karthik; Staffa, Steven J.; Zurakowski, David; Donofrio, Mary T.; Downing, Tacy E.; d’Udekem, Yves; Jonas, Richard A.; Yerebakan, Can; Clauss, Sarah; Kalinger, Kathleen; Kanter, Joshua P.; Muñoz, Ricardo; Peer, Syed Murfad; Sinha, Pranava; Wernovsky, Gil

doi:10.1016/j.jtcvs.2021.11.103

Cited by 18 publications

(10 citation statements)

References 26 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Similarly, four studies presented transplant-free survival in 311 patients with median duration of follow-up of 1.1 years (interquartile range, 0.3-7.4). 20,47,48,50 The pooled overall transplant-free survival was 62.6% at one year and 58.6% at two years after HP, respectively (Figure 2C). The decision to limit analysis to two years was made based on the median follow-up duration and varying follow-up between individual centers with the goal of preventing overrepresentation of a single center with substantially longer follow-up compared with the other included studies.…”

Section: Resultsmentioning

confidence: 98%

“…As a result, 33 studies were included in this systematic review and meta-analysis describing data from 1998 to 2022 (Figure 1). 4-6,20-48 Common reasons for eliminating studies were mixed lesions, non-HP studies and studies with >50% data before 1998. Other reasons included non-HLHS lesions, death or HTX not being the primary outcome of interest and narrative reviews.…”

Section: Resultsmentioning

confidence: 99%

“…Ten studies presented cumulative incidence of mortality in 488 patients following an initial HP approach with median duration of follow-up of 1.8 years (interquartile range, 0.5-5.0). 21,22,28,34,37,41,42,46,48,50 Our KM analyses revealed overall survival of 71.2% and 67.9% at one and two years after HP, respectively (Figure 2B). Similarly, four studies presented transplant-free survival in 311 patients with median duration of follow-up of 1.1 years (interquartile range, 0.3-7.4).…”

Section: Mortality and Heart Transplantation Outcomesmentioning

confidence: 85%

See 2 more Smart Citations

Mortality and Heart Transplantation After Hybrid Palliation of Hypoplastic Left Heart Syndrome: A Systematic Review and Meta-Analysis

Jacquemyn,

Singh,

Gossett

et al. 2024

World J Pediatr Congenit Heart Surg

View full text Add to dashboard Cite

Background Newborns with hypoplastic left heart syndrome (HLHS) who are considered at increased risk for death following Norwood/Sano surgery often undergo hybrid palliation (HP) as initial surgery. We aimed to compile the HP experience in HLHS and its variants and assess the rates of, and risk factors for, death and heart transplantation. Methods CINAHL, CINAHL PLUS, PubMed/MEDLINE, and SCOPUS were systematically searched for HP outcome studies of death or heart transplantation in HLHS between 1998 and 2022. Pooled incidence was estimated, and potential risk factors were identified using random-effects meta-analysis and reconstructed time-to-event data from Kaplan-Meier curves. Results Thirty-three publications were included in our review. Overall, of 1,162 patients 417 died and 57 underwent heart transplantation, resulting in a combined outcome of 40.7%, (474/1,162). There was a trend toward decreasing mortality risk across the stages of palliation. Pooled mortality between HP and comprehensive stage 2 palliation was 25%, after stage 2 up to Fontan palliation was 16%, and 6% post-Fontan. The incidence of death or heart transplantation was higher in high-risk patients—43% died and 10% received heart transplantation. Conclusion Our systematic review and meta-analysis found high rates of death or heart transplantation in HP of HLHS patients between HP and Fontan surgeries. All patients should be closely followed during the initial interstage period, which is associated with the highest hazard. Prospective studies on appropriate patient selection, indications, and / or alternatives, as well as refining HP strategies for managing newborns with HLHS are needed to improve outcomes.

show abstract

Section: Resultsmentioning

confidence: 98%

Section: Resultsmentioning

confidence: 99%

Section: Mortality and Heart Transplantation Outcomesmentioning

confidence: 85%

See 1 more Smart Citation

Mortality and Heart Transplantation After Hybrid Palliation of Hypoplastic Left Heart Syndrome: A Systematic Review and Meta-Analysis

Jacquemyn,

Singh,

Gossett

et al. 2024

World J Pediatr Congenit Heart Surg

View full text Add to dashboard Cite

show abstract

“…The "hybrid" approach, consisting of bilateral pulmonary artery banding, atrio-septostomy and ductal stent, was first introduced by a team in Giessen, Germany. In the beginning, the hybrid approach was utilized only for the high-risk patients, but eventually offered to others with satisfactory outcomes (103)(104)(105)(106)(107)(108)(109). Recently, for neonates with hypoplastic left heart structures in critical condition due to pulmonary over-circulation and insufficient systemic perfusion with subsequent multi-organ failure (110), we adopted this policy, deferring the Norwood procedure and the required cardiopulmonary bypass in neonates with depleted metabolic and functional reserves.…”

Section: Hybrid Proceduresmentioning

confidence: 99%

Narrative review of single ventricle: where are we after 40 years?

Corno¹,

Findley²,

Salazar³

2023

Transl Pediatr

View full text Add to dashboard Cite

Background and Objective: Key medical and surgical advances have been made in the longitudinal management of patients with "functionally" single ventricle physiology, with the principles of Fontan circulation applied to other complex congenital heart defects. The purpose of this article is to review all of the innovations, starting from fetal life, that led to a change of strategy for single ventricle.Methods: Our literature review included all full articles published in English language on the Cochrane, MedLine, and Embase with references to "single ventricle" and "univentricular hearts", including the initial history of the treatments for this congenital heart defects as well as the innovations reported within the last decades.

show abstract

“…We suggest that the hybrid palliation with bilateral pulmonary artery banding with/out subsequent ductal stenting is a suitable option for patients with hypoplastic left heart complex with the presence of ductal flow, which would allow planned delayed decision-making and possibly more favorable course. 6 While an initial univentricular approach would be an option that many centers would favor, the hybrid approach would give those patients various possible trajectories from later single-ventricle palliation with a comprehensive stage II operation to direct or more complex biventricular repair and even a bridge to heart transplantation. This can all be accomplished by avoiding the use of cardiopulmonary bypass and related intra-or postoperative Early mitral valve intervention in Shone's complex may improve early survival.…”

mentioning

confidence: 99%