Abstract 17667: Surgical Palliation Strategy Does Not Affect Inter-Stage Ventricular Dysfunction or Atrioventricular Valve Regurgitation in Children with Hypoplastic Left Heart Syndrome
Background: We hypothesized that surgical palliation strategy may affect inter-stage ventricular function and atrioventricular valve regurgitation (AVVR) in patients with hypoplastic left heart syndrome.
Methods: All echocardiograms were reviewed for 138 children palliated with Hybrid (H; n=54), Norwood/BT Shunt (N; n=73), or Sano (S; n=11) strategies from 2004 to 2011. Cardiac arrest and requirement of extracorporeal membrane oxygenation (ECMO) were defined as adverse events. Differences between strategies were compared with Kaplan-Meier analysis. Cox multivariable regression was used to identify risk factors.
Results: Freedom from moderate/severe ventricular dysfunction was comparable among groups at 3 and 6 months after stage I (H: 81%, 71%; N: 72%, 67%; S: 91%, 68%; p=0.73) and at 2 years after stage II palliation (H: 65%; N: 73%; S: 69%; p=0.70). Predictors for ventricular dysfunction were ECMO (p=0.001; stage I to II), longer open chest time (p=0.003; stage I to II), and longer ICU stay (p<0.001; stage II to III). There was a reduction in freedom from ventricular dysfunction following adverse events in all 3 groups (Figure 1A). Patients with ventricular dysfunction had lower transplant-free survival regardless of palliation strategy used (p<0.001; Figure 1B). Palliation strategy did not affect the incidence of AVVR after stage 1 (p=0.87) or stage 2 (p=0.71). Predictors for AVVR were post-stage I ventricular dysfunction (p=0.003; stage I to II), cardiac arrest/CPR (p=0.003; stage I to II), and post-stage II ventricular dysfunction (p=0.002; stage II to III).
Conclusion: Palliation strategy does not influence inter-stage ventricular function or AVVR. Ventricular dysfunction is the strongest predictor of poor outcome regardless of palliation strategy and is often related to cardiac arrest/ECMO. This emphasizes the importance of early detection of ventricular dysfunction and optimal heart failure treatment to improve 1 year survival in this entity.
- © 2012 by American Heart Association, Inc.