Abstract 16244: Survival, Reintervention, and Pulmonary Vascular Status After Stage II Palliation for Neonate with Hypoplastic Left Heart Syndrome: Hybrid vs. Norwood Strategies
BACKGROUND: Our previous study showed equivalent survival and pulmonary artery (PA) growth after Stage I palliation between infants with hypoplastic left heart syndrome (HLHS) palliated with a Norwood or Hybrid strategy. Because these divergent strategies converge at the Fontan procedure, we sought to compare the strategies in terms of survival, reintervention rates, and PA growth at pre-Fontan evaluation.
METHODS: We reviewed 110 infants treated with hybrid (n=47) or Norwood (Blalock-Taussig shunt; n=63) single ventricle palliation between 2004 and 2010. Unplanned reintervention included stent placement in a PA and/or caval veins, or balloon dilation of the aorta. Survival and reintervention between the groups were compared by a Kaplan-Meier survival analysis, and the pre-Fontan comparison was made by Man-Whitney U test.
RESULTS: 75 (68%) infants underwent Stage II (Hybrid: 32 vs. Norwood: 43). The freedom from death or transplant after stage II was similar between groups (Hybrid vs. Norwood: 88% vs. 84% at 3 years, p=0.95). Unplanned reintervention rates at 3 years were higher in the Hybrid group (31.3% vs. 9.3%, p=0.016) (Figure 1). 39 (Hybrid: 14 vs. Norwood: 25) children had Fontan completion with no mortality. Pre-Fontan catheterization and echocardiograms showed equivalent PA growth and ventricular performance (Table 1).
CONCLUSION: Despite having more unplanned reintervention following stage II palliation, the hybrid palliation brought equivalent the survival, PA growth and ventricular performance at pre-Fontan evaluation. An ongoing prospective randomized trial including neurological outcomes may determine the superiority of one strategy to the other.
- © 2011 by American Heart Association, Inc.