Abstract 17145: Salvage Hybrid Palliation for Critically-Ill Infants With Functionally Single-Ventricle Physiology
Introduction: We sought to determine the efficacy of the Hybrid procedure as a salvage strategy (Salvage-Hybrid) for critically-ill infants with hypoplastic left heart syndrome and variants. We hypothesized that Salvage-Hybrid palliation would serve as an important step in stabilizing patients so they could achieve the next stage of palliation or transplantation.
Methods: Stage I palliation was performed in 173 patients (Hybrid: 67, Norwood: 93, Salvage-Hybrid: 13) from 2004 to 2013. Salvage-Hybrid included bilateral PA bands in all patients with ductal stent (n= 9), atrial septal dilatation/stent (n=8), and/or a reverse BT shunt (n=2). Indications included hemodynamic instability in 5 (38%), ventricular dysfunction in 3 (23%), CPB contraindication in 3 (23%), hemodynamic instability and ventricular dysfunction in 1 (8%), and extreme low body weight in 1 (8%). Necrotizing enterocolitis was a secondary indication in 4 (31%) patients. Kaplan-Meier analysis was used to compare the 3 strategies.
Results: Preoperatively, all 13 (100%) patients were on PGE therapy, 12 (92%) required intubation, 4 (31%) had ventricular dysfunction, 2 (15%) required ECMO, and 1 (8%) required CPR. Six (46%) patients had at least temporary improvements in hemodynamic status with 3 (23%) achieving stage II palliation, 2 (15%) achieving transplantation, and 1 (8%) reaching high-risk biventricular repair (Figure 1A). Seven (54%) patients died (3 early, 4 late) without making it to subsequent operations due to circulatory failure in 3, neurologic injury in 1, shock in 1, and unknown causes in 2. Freedom from death before subsequent operation at 6 months was lower in this cohort (47%) vs. both Norwood (81%) and Hybrid (84%) groups (p=0.001; Figure 1B).
Conclusions: Hybrid palliation as a salvage strategy for critically-ill single-ventricle patients rescued approximately half of the patients whose survival was otherwise dismal with a conventional strategy.
- © 2013 by American Heart Association, Inc.