Journal
JOURNAL OF THORACIC AND CARDIOVASCULAR SURGERY
Volume 153, Issue 1, Pages 163-+Publisher
MOSBY-ELSEVIER
DOI: 10.1016/j.jtcvs.2016.08.021
Keywords
congenital heart disease; single ventricle; critical left ventricular outflow tract obstruction; hypoplastic left heart syndrome; hybrid; Norwood
Funding
- Congenital Heart Surgeons' Society
- Department of Cardiovascular Surgery, The Hospital for Sick Children
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Background: For neonates with critical left ventricular outflow tract obstruction (LVOTO), hybrid procedures are an alternative to the Norwood stage 1 procedure. Despite perceived advantages, however, outcomes are not well defined. Therefore, we compared outcomes after stage 1 hybrid and Norwood procedures. Methods: In a critical LVOTO inception cohort (2005-2014; 20 institutions), a total of 564 neonates underwent stage 1 palliation with the Norwood operation with a modified Blalock-Taussig shunt (NW-BT; n = 232; 41%), Norwood operation with a right ventricle-to-pulmonary artery conduit (NW-RVPA; n = 222; 39%), or a hybrid procedure (n = 110; 20%). Post-stage 1 outcomes were analyzed via competing-risks and parametric hazard analyses and compared among all 564 patients and between patients who underwent propensity-matched hybrid and those who underwent NW-BT/NW-RVPA. Results: By 6 years after the stage 1 operation, 50% +/- 3%, 7% +/- 2%, and 4% +/- 1% of patients transitioned to Fontan, transplantation, and biventricular repair, respectively, whereas 7% +/- 2% were alive without transition and 32% +/- 2% died. Risk factors for death without transition included procedure type, smaller ascending aorta, aortic valve atresia, and lower birth weight. Risk-adjusted 4-year survival was better after NW-RVPA than after NW-BT or hybrid (76% vs 60% vs 61%; P < .001). Furthermore, for neonates with lower birth weight (
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