The Evolution of Therapeutic Strategies: Niche Apportionment for Hybrid Palliation

Haller, Christoph; Caldarone, Christopher A.

doi:10.1016/j.athoracsur.2018.05.048

Cited by 18 publications

(24 citation statements)

References 82 publications

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“…Furthermore, the ratio of fetal hemoglobin affects the correlation between PaO2 and SaO2. Therefore, the target of SaO2 had a relatively wide range between 75 and 85% [4] or 70 and 80% [14] as well as 70 and 80 in the present study. In addition, PaO2 and SaO2 are not available in patients with biventricular physiology.…”

Section: Pulmonary Blood Flow Distributionmentioning

confidence: 58%

“…3A). The right PSV was smaller than the left PSV (P = 0.030) because it was difficult to obtain the correct Doppler angle at the RPAB, resulting in underestimation of the velocity [4]. The intraoperative EDV to PSV ratios in the RPAB and LPAB were 0.50 ± 0.07 and 0.51 ± 0.06, respectively (Fig.…”

Section: Echocardiographic Assessment Of Psv and Edv To Psv Ratiomentioning

confidence: 95%

“…However, a standard method to obtain appropriate tightness has not been established and adjustment of the tightness is technically challenging due to the small branch pulmonary artery. Furthermore, not only balanced systemic-to-pulmonary blood flow but also nearly equal flow distribution to each lung should be considered to achieve the optimal tightness of the BPAB [4].…”

Section: Introductionmentioning

confidence: 99%

“…The hemodynamics after the BPAB has a diastolic pulmonary runoff as seen with systemic to pulmonary artery shunt and persistent ductus arteriosus (PDA) [4]. In neonates, a PDA in patients with low pulmonary arterial pressure have continuous left-to-right shunt with peak flow velocity and the end-diastolic flow velocity (EDV) to the peak systolic flow velocity (PSV) ratio greater than 0.5 has been recently reported as one of the indicators to assess non-hemodynamically significant or restrictive PDA with transthoracic echocardiography which was related to magnetic resonance imaging statistically [5][6][7][8][9].…”

Section: Introductionmentioning

confidence: 99%

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A valuable echocardiographic indicator for the optimal tightness of bilateral pulmonary artery banding

Koshiyama

Takeuchi

Katagiri

et al. 2021

Gen Thorac Cardiovasc Surg

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ObjectivesThe optimal tightness of bilateral pulmonary artery banding (BPAB) is considered to balance not only systemicto-pulmonary blood flow but also each pulmonary blood flow, which is still challenging. To achieve them, we adopt the enddiastolic velocity (EDV) to the peak systolic velocity (PSV) ratio at BPAB with intraoperative epicardial echocardiography. We evaluated the usefulness of the EDV to PSV ratio and the patient outcomes. Methods 34 patients underwent BPAB with this indicator and using a looped polytetrafluoroethylene suture. The PSV and the EDV to PSV ratio with echocardiography were measured in the intraoperative, early postoperative and late postoperative period. Lung perfusion scintigraphy was performed to quantify flow to each lung. Results There were 3 early deaths (< 30 days). Two patients required re-BPAB due to hypoxia. The intraoperative EDV to PSV ratios in the right and left were almost equal (0.50 ± 0.07 versus 0.51 ± 0.06, P = 0.73). There was no significant difference in the right and left EDV to PSV ratios throughout the postoperative course. The right PSV was smaller than the left PSV due to the Doppler angle intraoperatively (2.78 ± 0.57 versus 3.02 ± 0.50, P = 0.030). In addition, the PSV changed significantly until the late postoperative period (P < 0.001). Lung perfusion scintigraphy revealed only two patients had perfusion abnormalities. Conclusions Our clinical outcomes are satisfactory with low early mortality and a low rate of re-BPAB. The EDV to PSV ratio can be a reliable indicator to assess flow distribution to each lung and may be a valuable adjunct to achieve balanced systemic to pulmonary flow.

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Section: Pulmonary Blood Flow Distributionmentioning

confidence: 58%

Section: Echocardiographic Assessment Of Psv and Edv To Psv Ratiomentioning

confidence: 95%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

A valuable echocardiographic indicator for the optimal tightness of bilateral pulmonary artery banding

Koshiyama

Takeuchi

Katagiri

et al. 2021

Gen Thorac Cardiovasc Surg

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“…Univentricular-biventricular decision deferral: stabilization of hemodynamics and control of PBF in a patient with borderline left heart structures in whom feasibility for biventricular repair is uncertain in the neonatal period, with consideration for maintenance of a restrictive atrial septum (Table 1). 41 Creating a standard language with respect to palliative intent and risk stratification is necessary to accurately assess hybrid outcomes. That is, to compare "apples to apples" and thus determine the ideal setting for hybrid stage 1 use, a clear understanding of hybrid intent and patient characteristics is necessary.…”

Section: Current Strategies For Hybrid Palliationmentioning

confidence: 99%

Apples to oranges: Making sense of hybrid palliation for hypoplastic left heart syndrome

Wilder

Caldarone

2020

JTCVS Open

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Feature Editor's Introduction-Hypoplastic left heart syndrome (HLHS) remains one of the most challenging anomalies for the surgical repertoire. Despite initial nearly overwhelming enthusiasm for a hybrid strategy as the first surgical step in single-ventricle palliation, the hybrid procedure did not show convincing superiority over conventional stage 1 surgical palliation. Here, experts discuss the role, pitfalls, potential benefits, and outcomes of the hybrid procedure. See Commentaries on pages 55 and 56.

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Palliative Operations

Backer

Mavroudis

2023

Pediatric Cardiac Surgery

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The Evolution of Therapeutic Strategies: Niche Apportionment for Hybrid Palliation

Cited by 18 publications

References 82 publications

A valuable echocardiographic indicator for the optimal tightness of bilateral pulmonary artery banding

A valuable echocardiographic indicator for the optimal tightness of bilateral pulmonary artery banding

Apples to oranges: Making sense of hybrid palliation for hypoplastic left heart syndrome

Palliative Operations

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