Initial experience with hybrid palliation for neonates with single-ventricle physiology

Hybrid palliation consisting of bilateral pulmonary artery banding and ductal stenting (PAB/DS) is an emerging method to palliate neonates with functional single ventricles.

Outcomes were reviewed for a newly established hybrid program. PAB/DS was performed in 18 patients for three indications: Norwood alternative (n = 11), pretransplant palliation (n = 5), and salvage (n = 2). Comparison is made with a concurrent group of 25 patients treated with a Norwood procedure.

Among Norwood-alternative patients, there were two deaths, followed by nine stage II procedures, with one death. One salvage patient died. All pretransplant palliation patients underwent subsequent transplantation, with one death 49 days after the transplantation. Three deaths were due to clearly defined technical errors, and one death (salvage patient) was due to an error in patient selection. Kaplan-Meier survival at 1 year was 68% for the hybrid patients. By indication, survival at 1 year was 80.0% for Norwood-alternative, 69.7% for pretransplant palliation, and 50.0% for salvage (p = 0.31). Overall Norwood survival at 1 year was 71.4% (p = 0.56 vs overall hybrid). Among Norwood-alternative survivors, combined (stage I and stage II) intubation times and lengths of stay in the intensive care unit and in the hospital tended to be shorter than Norwood survivors but did not reach statistical significance (9.6 +/- 6.9, 15 +/- 8, and 35.7 +/- 15.3 days versus 15.4 +/- 4.9, 23.5 +/- 16.7, and 50.5 +/- 43.6 days, respectively, p = NS).

Despite comparison with a well-established Norwood program, a newly established hybrid program provides initial results that are comparable with those obtained with the Norwood procedure, suggesting that the learning curve in the current era is relatively short. As refinements in patient selection and technical issues evolve, survival can be expected to rapidly improve.