Abstract 2629: The Hybrid Comprehensive Stage 2 Palliation: Peri-Operative Results
Introduction: The hybrid stage I approach to single ventricle physiology combining transcatheter and surgical techniques can achieve acceptable short-term results in patients with hypoplastic left heart syndrome. The Comprehensive Stage 2 operation involves an aortic arch reconstruction, cavopulmonary anastomosis, and atrial septectomy. There are previously published reports of the lessons learned from years of modifying the hybrid strategy. The purpose of this study is to report a contemporary experience of the pre-operative, intra-operative, and post-operative outcomes of the Comprehensive Stage 2.
Methods: Between July 2004 and February 2006, 13 patients underwent a Comprehensive Stage 2 in our institution. A retrospective chart review was performed.
Results: Age of the patients was 5.4 to 7.6 months (median 6.8 months). No patient received circulatory arrest. Sixty-two percent (8/13) were extubated in the operating room. All patients were managed with milrinone initially (median initial inotropic score 0). The initial median lactate was 2.3 and decreased to 1.1 at 48 hours. No clinically significant arrhythmias were noted postoperatively, and single ventricle function was unchanged from pre-operatively in all patients. Thirty-eight percent (5/13) had pleural effusions but only 2 received chest tube placement. Ninety-two percent (12/13) took their first oral feed within 72 hours. Renal function was normal postoperatively. At discharge, oxygen saturations ranged from 71% to 85% (median 78%), with only one patient in need of supplemental oxygen. Survival was 92% with 1 death secondary to sepsis.
Conclusions: Contemporary short-term outcomes of the Comprehensive Stage 2 are comparable to other surgical staged approaches. Accrued experience may result in further improvements in outcome with the hybrid approach. Long-term follow-up and multi-institutional trials will determine the optimal surgical approach for hypoplastic left heart syndrome.