Staged Reconstruction for Hypoplastic Left Heart Syndrome

Bove, Edward L.; Lloyd, Thomas R.

doi:10.1097/00000658-199609000-00015

Cited by 225 publications

(149 citation statements)

References 15 publications

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“…Despite the favorable outcomes currently achieved with the first-stage mBT procedure, a 4% to 15% late death risk still persists before the second palliation stage 11,[27][28][29] , although the use of a home surveillance program could reduce this risk 30 . The use of a RV-PA conduit reduced interstage mortality among Norwood procedure survivors in a study published by Pizarro, in which 40 out of 46 Blalock-Taussig group patients and 49 out of 50 RV-PA conduit group patients achieved the hemi-Fontan stage with interim mortality rates of 13% and 2%, respectively 31 .…”

Section: Discussionmentioning

confidence: 99%

Síndrome da hipoplasia do coração esquerdo: a influência da estratégia cirúrgica nos resultados

Silva¹,

Fonseca²,

Baumgratz³

et al. 2007

Arq. Bras. Cardiol.

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SummaryObjectives: To report a surgical strategy for the Norwood procedure in the hypoplastic left heart syndrome (HLHS) that enables short hypothermic circulatory arrest time and aortic arch reconstruction with autologous pericardium patch, and to compare the results of the modified Blalock- Taussig Results: In-hospital survival for the entire cohort was 74.64%, or 67.57% and 82.35% for the mBT shunt and RV-PA conduit groups, respectively (p=0.1808). Mortality rates between the first and second palliation stages were 40% and 4.4% for the mBT shunt and RV-PA conduit groups, respectively (p=0.0054). Hypothermic circulatory arrest times were 45.79±1.99 min and 36.62±1.62min (p=0.0012), respectively. Late coarctation of the aorta occurred in five patients (7.2%).Conclusions: This surgical strategy resulted in short circulatory arrest time, low mortality and favorable morphology of the neoaorta, with low incidence of late coarctation of the aorta. The higher rate of survival to first palliation stage with the RV-PA conduit was not significant, but interstage mortality was statistically lower when compared with the modified Blalock-Taussig shunt procedure.

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Section: Discussionmentioning

confidence: 99%

Síndrome da hipoplasia do coração esquerdo: a influência da estratégia cirúrgica nos resultados

Silva¹,

Fonseca²,

Baumgratz³

et al. 2007

Arq. Bras. Cardiol.

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“…Our own experience and that reported from other centers suggests that early survival is significantly higher for those patients who do not have associated risks, such as genetic anomalies, low birth weight, and low Apgar scores. 6,14 Subsequent staging surgery also evolved considerably over the study period. In 1989, we began routine intermediate staging with the BCPA.…”

Section: Discussionmentioning

confidence: 99%

“…Several institutions have reported operative survival for the stage I procedure between 68% and 77%. [5][6][7] There has also been a reduction in operative mortality with subsequent staging procedures. 8,9 Modifications in the Fontan operation, such as fenestration of the Fontan baffle, and the introduction of intermediate staging with a bidirectional cavopulmonary anastomosis (BCPA) have contributed to this improved survival.…”

mentioning

confidence: 99%

Survival After Reconstructive Surgery for Hypoplastic Left Heart Syndrome : A 15-Year Experience From a Single Institution

Mahle

Spray²,

Wernovsky³

et al. 2000

Circulation

305

261

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Background-There are limited data regarding the long-term survival of patients who have undergone reconstructive surgery for hypoplastic left heart syndrome (HLHS). We reviewed the 15-year experience at our institution to examine survival in the context of continued improvements in early operative results. Methods and Results-Between 1984 and 1999, 840 patients underwent stage I surgery for HLHS. From review of medical records and direct patient contact, survival status was determined. The 1-, 2-, 5-, 10-, and 15-year survival for the entire cohort was 51%, 43%, 40%, 39%, and 39%, respectively. Late death occurred in 14 of the 291 patients discharged to home after the Fontan procedure, although only 1 patient has died beyond 5 years of age. Heart transplantation after stage I reconstruction was performed in 5 patients. Later era of stage I surgery was associated with significantly improved survival (PϽ0.001). Three-year survival for patients undergoing stage I reconstruction from 1995 to 1998 was 66% versus 28% for those patients undergoing surgery from 1984 to 1988. Age Ͼ14 days at stage I and weight Ͻ2.5 kg at stage I were also associated with higher mortality (Pϭ0.004 and Pϭ0.01, respectively). Other variables, including anatomic subtype, heterotaxia, and age at subsequent staging procedures, were not associated with survival. Conclusions-Over

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“…H ighly restrictive or intact atrial septum (RAS) in the setting of hypoplastic left heart syndrome (HLHS) occurs in approximately 6% to 11% of cases [1][2][3] and is associated with poor short-and medium-term outcomes [1][2][3][4][5][6] despite evolving strategies [1][2][3]7,8 to urgently decompress the left atrium and diminish left atrial hypertension in the immediate postnatal period. Persistent mortality despite relief of RAS in these patients may be partly a result of muscularization of the pulmonary arteries and arterialization of the pulmonary veins because of chronic in utero pulmonary venous hypertension.…”

mentioning

confidence: 99%

Predictive Value of Fetal Pulmonary Venous Flow Patterns in Identifying the Need for Atrial Septoplasty in the Newborn With Hypoplastic Left Ventricle

et al. 2005

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Background-Pulmonary venous Doppler (PVD) flow patterns in the fetus with hypoplastic left heart syndrome (HLHS) have been correlated with restrictive interatrial communication or intact atrial septum (RAS) postnatally; however, the ability of PVD to identify the neonate requiring emergent atrial septoplasty (EAS) for severe left atrial hypertension and hypoxemia has not been critically evaluated. It was the purpose of this study to determine the predictive power of fetal PVD in identifying the need for EAS in newborns with HLHS and RAS. Methods and Results-Forty-one patients with fetal PVD flow analysis and postnatally confirmed HLHS were studied.Pulsed-wave assessment of PVD flow included S-, D-, and A-wave velocity, time-velocity integral (VTI) of forward and reverse flow, and S/D velocity and forward/reverse VTI ratio. Neonatal EAS was used as the primary clinical outcome variable. Receiver operating characteristic curves were used to determine cutpoints at which PVD indices best predicted EAS. Cutpoints were evaluated for clinical accuracy and usefulness by use of Bayesian analysis. Eight of 41 subjects underwent EAS. Need for EAS was most accurately predicted by forward/reverse VTI ratio Ͻ5 (sensitivity, 0.88, 95% CI, 0.49 to 0.99; specificity, 0.97, 95% CI, 0.82 to 0.99), which, when present, increases the posttest likelihood of EAS to 74%, assuming a pretest prevalence of 10%. Accuracy and usefulness of other PVD indices were affected by false-positive results. Conclusions-In the fetus with HLHS, a PVD forward/reverse VTI ratio of Ͻ5 is the strongest predictor of the need for EAS in the newborn period. These observations should improve our ability to identify and expectantly manage the fetus with HLHS and RAS.

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Staged Reconstruction for Hypoplastic Left Heart Syndrome

Cited by 225 publications

References 15 publications

Síndrome da hipoplasia do coração esquerdo: a influência da estratégia cirúrgica nos resultados

Síndrome da hipoplasia do coração esquerdo: a influência da estratégia cirúrgica nos resultados

Survival After Reconstructive Surgery for Hypoplastic Left Heart Syndrome : A 15-Year Experience From a Single Institution

Predictive Value of Fetal Pulmonary Venous Flow Patterns in Identifying the Need for Atrial Septoplasty in the Newborn With Hypoplastic Left Ventricle

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