Single-ventricle palliation for high-risk neonates: The emergence of an alternative hybrid stage I strategy

Emile A. Bacha, Suanne Daves, Joel Hardin, Ra Id Abdulla, Jennifer Anderson, Madelyn Kahana, Peter Koenig, Bassem N. Mora, Mehmet Gulecyuz, Joanne P. Starr, Ernerio Alboliras, Satinder Sandhu, Ziyad M. Hijazi

Research output: Contribution to journalArticle

146 Citations (Scopus)

Abstract

Background: Survival after stage I palliation for hypoplastic left heart syndrome or related anomalies remains poor in high-risk neonates. We hypothesized that a less invasive hybrid approach would be beneficial in this patient population. Methods: The hybrid stage I procedure was performed in the catheterization laboratory. Via a median sternotomy, both branch pulmonary arteries were banded, and a ductal stent was delivered via a main pulmonary artery puncture and positioned under fluoroscopic guidance. Results: Between October 2003 and June 2005, 14 high-risk neonates underwent a hybrid stage I procedure. Eleven of 14 had hypoplastic left heart syndrome. Two also underwent peratrial atrial septal stenting, and 5 required percutaneous atrial stenting later. Two neonates with an intact or highly restrictive atrial septum had emergency percutaneous atrial stent placement. Hospital survival was 11 (78.5%) of 14. One patient required extracorporeal membrane oxygenation support for intraoperative cardiac arrest. He underwent cardiac transplantation but died later of sepsis. One patient died of ductal stent embolization, and a third died of progressive cardiac dysfunction. The first 4 patients required pulmonary artery band revisions. There were none after we modified our technique and added branch pulmonary artery angiograms. There were 2 interstage deaths from atrial stent occlusion and from preductal retrograde coarctation. Eight patients underwent stage II procedures, consisting of aortic arch reconstruction, atrial septectomy, and cavopulmonary shunt. Two patients died after stage II. One patient is awaiting stage II. Conclusions: The hybrid stage I palliation is a valid option in high-risk neonates. As experience is accrued, it may become the preferred alternative. However, in aortic atresia, the development of preductal retrograde coarctation is a significant problem.

Original languageEnglish (US)
JournalJournal of Thoracic and Cardiovascular Surgery
Volume131
Issue number1
DOIs
StatePublished - Jan 2006
Externally publishedYes

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Newborn Infant
Pulmonary Artery
Stents
Hypoplastic Left Heart Syndrome
Right Heart Bypass
Atrial Septum
Extracorporeal Membrane Oxygenation
Sternotomy
Survival
Heart Transplantation
Heart Arrest
Thoracic Aorta
Punctures
Catheterization
Sepsis
Angiography
Emergencies
Population

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Surgery

Cite this

Single-ventricle palliation for high-risk neonates : The emergence of an alternative hybrid stage I strategy. / Bacha, Emile A.; Daves, Suanne; Hardin, Joel; Abdulla, Ra Id; Anderson, Jennifer; Kahana, Madelyn; Koenig, Peter; Mora, Bassem N.; Gulecyuz, Mehmet; Starr, Joanne P.; Alboliras, Ernerio; Sandhu, Satinder; Hijazi, Ziyad M.

In: Journal of Thoracic and Cardiovascular Surgery, Vol. 131, No. 1, 01.2006.

Research output: Contribution to journalArticle

Bacha, EA, Daves, S, Hardin, J, Abdulla, RI, Anderson, J, Kahana, M, Koenig, P, Mora, BN, Gulecyuz, M, Starr, JP, Alboliras, E, Sandhu, S & Hijazi, ZM 2006, 'Single-ventricle palliation for high-risk neonates: The emergence of an alternative hybrid stage I strategy', Journal of Thoracic and Cardiovascular Surgery, vol. 131, no. 1. https://doi.org/10.1016/j.jtcvs.2005.07.053
Bacha, Emile A. ; Daves, Suanne ; Hardin, Joel ; Abdulla, Ra Id ; Anderson, Jennifer ; Kahana, Madelyn ; Koenig, Peter ; Mora, Bassem N. ; Gulecyuz, Mehmet ; Starr, Joanne P. ; Alboliras, Ernerio ; Sandhu, Satinder ; Hijazi, Ziyad M. / Single-ventricle palliation for high-risk neonates : The emergence of an alternative hybrid stage I strategy. In: Journal of Thoracic and Cardiovascular Surgery. 2006 ; Vol. 131, No. 1.
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AU - Anderson, Jennifer

AU - Kahana, Madelyn

AU - Koenig, Peter

AU - Mora, Bassem N.

AU - Gulecyuz, Mehmet

AU - Starr, Joanne P.

AU - Alboliras, Ernerio

AU - Sandhu, Satinder

AU - Hijazi, Ziyad M.

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