Analysis of preoperative condition and interstage mortality in Norwood and hybrid procedures for hypoplastic left heart syndrome using the Aristotle scoring system

David F. A. Lloyd, Lindsay Cutler, Shane M. Tibby, Sunitha Vimalesvaran, Shakeel Ahmed Qureshi, Eric Rosenthal, David Anderson, Conal Austin, Hannah Bellsham-Revell, Thomas Krasemann*

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

39 Citations (Scopus)

Abstract

Objective

The 'hybrid procedure', consisting of surgical banding of the pulmonary arteries with intraoperative stenting of the arterial duct, was developed as primary palliation in hypoplastic left heart syndrome (HLHS), avoiding the risks of cardiopulmonary bypass. In many centres, it is reserved for low birth weight, premature or unstable neonates; however, its role in such high risk cases of HLHS has yet to be defined.

Methods

The preoperative condition of all patients with HLHS who underwent either the hybrid or the Norwood procedure for HLHS between 2005-2011 was analysed retrospectively, using a modified comprehensive Aristotle score. We then compared operative, interstage and 1 year mortalities between the groups after Aristotle adjustment via Cox proportional hazards analyses.

Results

Of 138 patients with HLHS, 27 had hybrid and 111 Norwood procedures. The hybrid group had significantly higher Aristotle scores (mean 4.1 vs 1.8; p <0.001); however, there was no significant difference in mortality at any stage. At 1 year, the overall unadjusted survival among Norwood and hybrid patients was 58.6% and 51.9%, respectively, yielding an Aristotle adjusted hazard ratio for mortality among hybrid patients of 1.09 (95% CI 0.56 to 2.11, p=0.80).

Conclusions

Applying a hybrid approach to high risk patients with HLHS produces a comparable early and interstage mortality risk to lower risk patients undergoing the Norwood procedure. Prospective studies are needed to establish whether the hybrid procedure is a viable alternative to the Norwood procedure in all HLHS patients in terms of both mortality and long term morbidity.

Original languageEnglish
Pages (from-to)775-780
Number of pages6
JournalHeart
Volume100
Issue number10
DOIs
Publication statusPublished - 15 May 2014

Keywords

  • Congenital Heart Disease
  • NEURODEVELOPMENTAL OUTCOMES
  • RISK ADJUSTMENT
  • CARDIAC-SURGERY
  • PALLIATION
  • COMPLEXITY
  • SCORES
  • AGE

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