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

doi:10.1136/heartjnl-2013-304759

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

Cardiovascular Imaging

GSTT Guy's and St Thomas' NHS Foundation Trust

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

42 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 language	English
Pages (from-to)	775-780
Number of pages	6
Journal	Heart
Volume	100
Issue number	10
DOIs	https://doi.org/10.1136/heartjnl-2013-304759
Publication status	Published - 15 May 2014

Keywords

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

UN SDGs

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

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10.1136/heartjnl-2013-304759

Cite this

Lloyd, D. F. A., Cutler, L., Tibby, S. M., Vimalesvaran, S., Qureshi, S. A., Rosenthal, E., Anderson, D., Austin, C., Bellsham-Revell, H., & Krasemann, T. (2014). Analysis of preoperative condition and interstage mortality in Norwood and hybrid procedures for hypoplastic left heart syndrome using the Aristotle scoring system. Heart, 100(10), 775-780. https://doi.org/10.1136/heartjnl-2013-304759

@article{0d9018d10def433aa575de37941898a2,

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

abstract = "ObjectiveThe '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.MethodsThe 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.ResultsOf 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).ConclusionsApplying 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.",

keywords = "Congenital Heart Disease, NEURODEVELOPMENTAL OUTCOMES, RISK ADJUSTMENT, CARDIAC-SURGERY, PALLIATION, COMPLEXITY, SCORES, AGE",

author = "Lloyd, {David F. A.} and Lindsay Cutler and Tibby, {Shane M.} and Sunitha Vimalesvaran and Qureshi, {Shakeel Ahmed} and Eric Rosenthal and David Anderson and Conal Austin and Hannah Bellsham-Revell and Thomas Krasemann",

year = "2014",

month = may,

day = "15",

doi = "10.1136/heartjnl-2013-304759",

language = "English",

volume = "100",

pages = "775--780",

journal = "Heart",

issn = "1355-6037",

publisher = "BMJ Publishing Group Ltd",

number = "10",

}

Lloyd, DFA, Cutler, L, Tibby, SM, Vimalesvaran, S, Qureshi, SA , Rosenthal, E , Anderson, D , Austin, C , Bellsham-Revell, H & Krasemann, T 2014, 'Analysis of preoperative condition and interstage mortality in Norwood and hybrid procedures for hypoplastic left heart syndrome using the Aristotle scoring system', Heart, vol. 100, no. 10, pp. 775-780. https://doi.org/10.1136/heartjnl-2013-304759

TY - JOUR

T1 - Analysis of preoperative condition and interstage mortality in Norwood and hybrid procedures for hypoplastic left heart syndrome using the Aristotle scoring system

AU - Lloyd, David F. A.

AU - Cutler, Lindsay

AU - Tibby, Shane M.

AU - Vimalesvaran, Sunitha

AU - Qureshi, Shakeel Ahmed

AU - Rosenthal, Eric

AU - Anderson, David

AU - Austin, Conal

AU - Bellsham-Revell, Hannah

AU - Krasemann, Thomas

PY - 2014/5/15

Y1 - 2014/5/15

N2 - ObjectiveThe '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.MethodsThe 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.ResultsOf 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).ConclusionsApplying 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.

AB - ObjectiveThe '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.MethodsThe 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.ResultsOf 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).ConclusionsApplying 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.

KW - Congenital Heart Disease

KW - NEURODEVELOPMENTAL OUTCOMES

KW - RISK ADJUSTMENT

KW - CARDIAC-SURGERY

KW - PALLIATION

KW - COMPLEXITY

KW - SCORES

KW - AGE

U2 - 10.1136/heartjnl-2013-304759

DO - 10.1136/heartjnl-2013-304759

M3 - Article

SN - 1355-6037

VL - 100

SP - 775

EP - 780

JO - Heart

JF - Heart

IS - 10

ER -

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

Abstract

Keywords

UN SDGs

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