Hybrid strategy in neonates with ductal-dependent systemic circulation and multiple risk factors

the Children's National Hospital Hybrid Working Group

doi:10.1016/j.jtcvs.2021.11.103

Hybrid strategy in neonates with ductal-dependent systemic circulation and multiple risk factors

the Children's National Hospital Hybrid Working Group

Surgery

Research output: Contribution to journal › Article › peer-review

19 Scopus citations

Abstract

Objective: The study objective was to analyze outcomes of the hybrid strategy for ductal-dependent systemic circulation consisting of bilateral pulmonary artery banding with or without ductal stenting followed by delayed Norwood-type palliation or comprehensive stage II operation in high-risk neonates. Methods: A retrospective analysis was performed between December 2017 and March 2021. Thirty high-risk neonates underwent palliation with bilateral pulmonary artery banding: 11 with prostaglandin therapy and 19 with ductal stenting. Median (range) age and body weight of patients at hybrid stage I were 3 days (0-43) and 2.9 kg (1.1-4.2), respectively. Operative and interstage mortality, morbidity, and reintervention rates were assessed. Results: Overall survival was 70% (21/30) at a median follow-up time of 9 months (range, 0-37) from hybrid stage I. Operative survival for hybrid stage I was 90% (27/30), of which 2 patients received palliative care, and there was 1 interstage death (4%, 1/27). After hybrid stage I, 37% of patients had a reintervention, and 3% (n = 1) used extracorporeal membrane oxygenation before the next stage of repair. Five patients are awaiting second-stage operation, and 9 patients are awaiting Fontan completion. Conclusions: High-risk neonates with hypoplastic left heart syndrome or its variants can be successfully palliated using the hybrid strategy and bridged to a delayed Norwood or comprehensive stage II operation with satisfactory survival. This operative approach is a promising alternative pathway for neonates deemed to be high risk due to multiple preoperative risk factors.

Original language	English (US)
Pages (from-to)	1291-1303.e6
Journal	Journal of Thoracic and Cardiovascular Surgery
Volume	164
Issue number	5
DOIs	https://doi.org/10.1016/j.jtcvs.2021.11.103
State	Published - Nov 2022

Bibliographical note

Funding Information:
The authors thank the Food and Drug Administration expanded access team for their assistance allowing the first-time use of the Sinus-Superflex-DS ductal stent in the United States; our former cardiac surgery fellows Lok Sinha, MD, and Syed Bukhari, MD, for their hard work in and outside of the operating room; our cardiac anesthesiology, cardiac perfusionist, and the NICU teams for their continuous and strong support; all of our dedicated nurse practitioners and clinical staff in the CICU and Heart and Kidney Unit for their outstanding care of these patients and their families; and our medical illustrator, Sofia Hanabergh, for editing the figures, illustrations, and video accompanying our manuscript.

Publisher Copyright:
© 2022 The American Association for Thoracic Surgery

Keywords

Norwood operation
hybrid
hypoplastic left heart syndrome
palliation
single ventricle

PubMed: MeSH publication types

Journal Article

UN SDGs

This output contributes to the following UN Sustainable Development Goals (SDGs)

Publisher link

10.1016/j.jtcvs.2021.11.103

Find It

Find It at U of M Libraries

Cite this

@article{15377d4a803b40e4b6524e96cd1ad413,

title = "Hybrid strategy in neonates with ductal-dependent systemic circulation and multiple risk factors",

abstract = "Objective: The study objective was to analyze outcomes of the hybrid strategy for ductal-dependent systemic circulation consisting of bilateral pulmonary artery banding with or without ductal stenting followed by delayed Norwood-type palliation or comprehensive stage II operation in high-risk neonates. Methods: A retrospective analysis was performed between December 2017 and March 2021. Thirty high-risk neonates underwent palliation with bilateral pulmonary artery banding: 11 with prostaglandin therapy and 19 with ductal stenting. Median (range) age and body weight of patients at hybrid stage I were 3 days (0-43) and 2.9 kg (1.1-4.2), respectively. Operative and interstage mortality, morbidity, and reintervention rates were assessed. Results: Overall survival was 70% (21/30) at a median follow-up time of 9 months (range, 0-37) from hybrid stage I. Operative survival for hybrid stage I was 90% (27/30), of which 2 patients received palliative care, and there was 1 interstage death (4%, 1/27). After hybrid stage I, 37% of patients had a reintervention, and 3% (n = 1) used extracorporeal membrane oxygenation before the next stage of repair. Five patients are awaiting second-stage operation, and 9 patients are awaiting Fontan completion. Conclusions: High-risk neonates with hypoplastic left heart syndrome or its variants can be successfully palliated using the hybrid strategy and bridged to a delayed Norwood or comprehensive stage II operation with satisfactory survival. This operative approach is a promising alternative pathway for neonates deemed to be high risk due to multiple preoperative risk factors.",

keywords = "Norwood operation, hybrid, hypoplastic left heart syndrome, palliation, single ventricle",

author = "{the Children's National Hospital Hybrid Working Group} and Ceneri, {Nicolle M.} and Desai, {Manan H.} and Aybala Tongut and Mahmut Ozturk and Karthik Ramakrishnan and Staffa, {Steven J.} and David Zurakowski and Donofrio, {Mary T.} and Tacy Downing and Yves d'Udekem and Jonas, {Richard A.} and Can Yerebakan and Sarah Clauss and Kathleen Kalinger and Joshua Kanter and Ricardo Munoz and Peer, {Syed M.} and Pranava Sinha and Gil Wernovsky",

note = "Funding Information: The authors thank the Food and Drug Administration expanded access team for their assistance allowing the first-time use of the Sinus-Superflex-DS ductal stent in the United States; our former cardiac surgery fellows Lok Sinha, MD, and Syed Bukhari, MD, for their hard work in and outside of the operating room; our cardiac anesthesiology, cardiac perfusionist, and the NICU teams for their continuous and strong support; all of our dedicated nurse practitioners and clinical staff in the CICU and Heart and Kidney Unit for their outstanding care of these patients and their families; and our medical illustrator, Sofia Hanabergh, for editing the figures, illustrations, and video accompanying our manuscript. Publisher Copyright: {\textcopyright} 2022 The American Association for Thoracic Surgery",

year = "2022",

month = nov,

doi = "10.1016/j.jtcvs.2021.11.103",

language = "English (US)",

volume = "164",

pages = "1291--1303.e6",

journal = "Journal of Thoracic and Cardiovascular Surgery",

issn = "0022-5223",

publisher = "Mosby Inc.",

number = "5",

}

TY - JOUR

T1 - Hybrid strategy in neonates with ductal-dependent systemic circulation and multiple risk factors

AU - the Children's National Hospital Hybrid Working Group

AU - Ceneri, Nicolle M.

AU - Desai, Manan H.

AU - Tongut, Aybala

AU - Ozturk, Mahmut

AU - Ramakrishnan, Karthik

AU - Staffa, Steven J.

AU - Zurakowski, David

AU - Donofrio, Mary T.

AU - Downing, Tacy

AU - d'Udekem, Yves

AU - Jonas, Richard A.

AU - Yerebakan, Can

AU - Clauss, Sarah

AU - Kalinger, Kathleen

AU - Kanter, Joshua

AU - Munoz, Ricardo

AU - Peer, Syed M.

AU - Sinha, Pranava

AU - Wernovsky, Gil

N1 - Funding Information: The authors thank the Food and Drug Administration expanded access team for their assistance allowing the first-time use of the Sinus-Superflex-DS ductal stent in the United States; our former cardiac surgery fellows Lok Sinha, MD, and Syed Bukhari, MD, for their hard work in and outside of the operating room; our cardiac anesthesiology, cardiac perfusionist, and the NICU teams for their continuous and strong support; all of our dedicated nurse practitioners and clinical staff in the CICU and Heart and Kidney Unit for their outstanding care of these patients and their families; and our medical illustrator, Sofia Hanabergh, for editing the figures, illustrations, and video accompanying our manuscript. Publisher Copyright: © 2022 The American Association for Thoracic Surgery

PY - 2022/11

Y1 - 2022/11

N2 - Objective: The study objective was to analyze outcomes of the hybrid strategy for ductal-dependent systemic circulation consisting of bilateral pulmonary artery banding with or without ductal stenting followed by delayed Norwood-type palliation or comprehensive stage II operation in high-risk neonates. Methods: A retrospective analysis was performed between December 2017 and March 2021. Thirty high-risk neonates underwent palliation with bilateral pulmonary artery banding: 11 with prostaglandin therapy and 19 with ductal stenting. Median (range) age and body weight of patients at hybrid stage I were 3 days (0-43) and 2.9 kg (1.1-4.2), respectively. Operative and interstage mortality, morbidity, and reintervention rates were assessed. Results: Overall survival was 70% (21/30) at a median follow-up time of 9 months (range, 0-37) from hybrid stage I. Operative survival for hybrid stage I was 90% (27/30), of which 2 patients received palliative care, and there was 1 interstage death (4%, 1/27). After hybrid stage I, 37% of patients had a reintervention, and 3% (n = 1) used extracorporeal membrane oxygenation before the next stage of repair. Five patients are awaiting second-stage operation, and 9 patients are awaiting Fontan completion. Conclusions: High-risk neonates with hypoplastic left heart syndrome or its variants can be successfully palliated using the hybrid strategy and bridged to a delayed Norwood or comprehensive stage II operation with satisfactory survival. This operative approach is a promising alternative pathway for neonates deemed to be high risk due to multiple preoperative risk factors.

AB - Objective: The study objective was to analyze outcomes of the hybrid strategy for ductal-dependent systemic circulation consisting of bilateral pulmonary artery banding with or without ductal stenting followed by delayed Norwood-type palliation or comprehensive stage II operation in high-risk neonates. Methods: A retrospective analysis was performed between December 2017 and March 2021. Thirty high-risk neonates underwent palliation with bilateral pulmonary artery banding: 11 with prostaglandin therapy and 19 with ductal stenting. Median (range) age and body weight of patients at hybrid stage I were 3 days (0-43) and 2.9 kg (1.1-4.2), respectively. Operative and interstage mortality, morbidity, and reintervention rates were assessed. Results: Overall survival was 70% (21/30) at a median follow-up time of 9 months (range, 0-37) from hybrid stage I. Operative survival for hybrid stage I was 90% (27/30), of which 2 patients received palliative care, and there was 1 interstage death (4%, 1/27). After hybrid stage I, 37% of patients had a reintervention, and 3% (n = 1) used extracorporeal membrane oxygenation before the next stage of repair. Five patients are awaiting second-stage operation, and 9 patients are awaiting Fontan completion. Conclusions: High-risk neonates with hypoplastic left heart syndrome or its variants can be successfully palliated using the hybrid strategy and bridged to a delayed Norwood or comprehensive stage II operation with satisfactory survival. This operative approach is a promising alternative pathway for neonates deemed to be high risk due to multiple preoperative risk factors.

KW - Norwood operation

KW - hybrid

KW - hypoplastic left heart syndrome

KW - palliation

KW - single ventricle

UR - http://www.scopus.com/inward/record.url?scp=85123986971&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=85123986971&partnerID=8YFLogxK

U2 - 10.1016/j.jtcvs.2021.11.103

DO - 10.1016/j.jtcvs.2021.11.103

M3 - Article

C2 - 35577592

AN - SCOPUS:85123986971

SN - 0022-5223

VL - 164

SP - 1291-1303.e6

JO - Journal of Thoracic and Cardiovascular Surgery

JF - Journal of Thoracic and Cardiovascular Surgery

IS - 5

ER -

Hybrid strategy in neonates with ductal-dependent systemic circulation and multiple risk factors

Abstract

Bibliographical note

Keywords

PubMed: MeSH publication types

UN SDGs

Publisher link

Find It

Other files and links

Fingerprint

Cite this