Second stage after initial hybrid palliation for hypoplastic left heart syndrome: Arterial or venous shunt?

Abstract

Both arterial and venous shunts are viable options with mortality and morbidity results comparable to those in the literature. The arterial shunt pathway (2-stage Norwood I) may offer better pulmonary arterial growth than the venous shunt (comprehensive/combined Norwood I and II).

Morphological three-dimensional analysis of papillary muscles in borderline left ventricles

“…This allows for more comprehensive surgery for left ventricle rehabilitation at a later age and at significantly larger size. [8][9][10] In our study, a consecutive group of patients with hypoplastic left heart syndrome and borderline cases was included. All the patients were initially managed with a hybrid procedure.…”

Comparison of self-expandable and balloon-expanding stents for hybrid ductal stenting in hypoplastic left heart complex

“…Multiple aspects of our learning curve developed, including a change in qualification criteria, introduction of three-dimensional echocardiography, CT, and nuclear magnetic resonance in initial evaluation and in assessment for timing and nature of further procedures. [23][24][25][26][27] We would consider, however, that the relative haemodynamic stability observed during and immediately after deploying self-expanding stents in the ductus has facilitated a less-morbid recovery period and contributed to higher overall survival at the point of censoring among selfexpanding stent patients (75 versus 56%, p = 0.132).…”

The Evolution of Therapeutic Strategies: Niche Apportionment for Hybrid Palliation

“…Other groups did not find significant differences in systemic ventricular function [45,46] but indicated that impaired systolic right ventricular strain and strain rate values may be indicative of a subclinical functional decline that becomes relevant during follow-up [46]. After aortic arch reconstruction, patients with initial hybrid palliation also showed higher arterial resistance but better Nassar [38] Pulmonary artery stent graft baffle instead of arch reconstruction at comprehensive stage II DeCampli [39] arterioventricular coupling compared with primary Norwood patients [47]. Bilateral pulmonary artery banding shows a similar diastolic pulmonary runoff than that seen with modified Blalock-Taussig shunts [42].…”

“…Nassar and colleagues [38] reported a two-stage Norwood I strategy using a systemic-to-pulmonary arterial shunt for pulmonary blood flow at a time when a comprehensive stage II conversion with a cavopulmonary anastomosis would have been an alternative strategy. The strategy is similar to a deferred Norwood strategy, although patients underwent the Norwood procedure relatively late, at approximately 12 weeks of age.…”

“…The strategy is similar to a deferred Norwood strategy, although patients underwent the Norwood procedure relatively late, at approximately 12 weeks of age. The group preferred a systemic arterial pulmonary blood source in patients expected to have increased pulmonary vascular resistance, patients necessitating an early stage II procedure, those needing complex venous reconstructions for the cavopulmonary connection, and in patients with small pulmonary arteries [38].…”