Key result
Hybrid palliation yields ~55% 12-year survival in infants with critical left heart obstruction.
Why the study?
Hybrid palliation is an initial management strategy for infants with critical left heart obstruction, and this study sought to determine patient characteristics and factors associated with subsequent outcomes.
What are the long-term clinical outcomes (biventricular repair, Fontan procedure, transplantation, or death) and associated risk factors in infants with critical left heart obstruction undergoing hybrid palliation?
Cohort (n=214)
Yes
What are the long-term clinical outcomes (biventricular repair, Fontan procedure, transplantation, or death) and associated risk factors in infants with critical left heart obstruction undergoing hybrid palliation?
Although mortality remains high after hybrid palliation for infants with critical left heart obstruction, the strategy can successfully bridge select infants to biventricular repair, Fontan palliation, or transplantation.
Answers are grounded in this paper and cite their sources.
High mortality persists after hybrid palliation; leaves open its selective role for biventricular repair or stabilization in observational data.
BACKGROUND Hybrid palliation (bilateral pulmonary artery banding with or without ductal stenting) is an initial management strategy for infants with critical left heart obstruction and serves as palliation until subsequent operations are pursued. OBJECTIVES This study sought to determine patient characteristics and factors associated with subsequent outcomes for infants who underwent hybrid palliation. METHODS From 2005 to 2019, 214 of 1,236 prospectively enrolled infants within the Congenital Heart Surgeons' Society's critical left heart obstruction cohort underwent hybrid palliation across 24 institutions. Multivariable hazard modeling with competing risk methodology was performed to determine risk and factors associated with outcomes of biventricular repair, Fontan procedure, transplantation, or death. RESULTS Preoperative comorbidities (eg, prematurity, low birth weight, genetic syndrome) were identified in 70% of infants (150 of 214). Median follow-up was 7 years, ranging up to 17 years. Overall 12-year survival was 55%. At 5 years after hybrid palliation, 9% had biventricular repair, 36% had Fontan procedure, 12% had transplantation, 35% died without surgical endpoints, and 8% were alive without an endpoint. Factors associated with transplantation were absence of ductal stent, older age, absent interatrial communication, smaller aortic root size, larger tricuspid valve area z-score, and larger left ventricular volume. Factors associated with death were low birth weight, concomitant genetic syndrome, cardiopulmonary bypass use during hybrid palliation, moderate to severe tricuspid valve regurgitation, and smaller ascending aortic size. CONCLUSIONS Mortality remains high after hybrid palliation for infants with critical left heart obstruction. Nonetheless, hybrid palliation may facilitate biventricular repair for some infants and for others may serve as stabilization for intended functional univentricular palliation or primary transplantation.
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Argo et al. (2023) conducted a cohort in Critical left heart obstruction (n=214). Hybrid palliation (bilateral pulmonary artery banding with or without ductal stenting) was evaluated on Competing outcomes of biventricular repair, Fontan procedure, transplantation, or death (and overall 12-year survival). Hybrid palliation in infants with critical left heart obstruction resulted in 55% 12-year survival; at 5 years, 36% had Fontan, 12% transplant, 9% biventricular repair, and 35% died without surgery.
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