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Published on: July 18, 2014
Left heart growth and biventricular repair after hybrid palliation
Vladimir Sojak1, Regina Bokenkamp2, Irene Kuipers3
1Department of Thoracic Surgery, Leiden University Medical Center, Leiden, Netherlands.
Insights
Hybrid palliation can promote left heart growth in infants with left ventricle hypoplasia, enabling more patients to achieve biventricular circulation. Further interventions may be necessary, and some may develop restrictive physiology.
Area of Science:
- Pediatric Cardiology
- Congenital Heart Disease
- Cardiac Surgery
Background:
- Left ventricle hypoplasia presents complex challenges in infant cardiac surgery.
- Initial hybrid palliation is a strategy to promote left heart growth before definitive repair.
Purpose of the Study:
- To evaluate the outcomes of biventricular repair following initial hybrid palliation in infants with left ventricle hypoplasia.
- To assess the effectiveness of hybrid palliation in facilitating left heart development.
Main Methods:
- A cohort of 27 infants with left ventricle hypoplasia underwent biventricular repair after hybrid palliation (median age 11 days).
- Indications for hybrid palliation included promoting left ventricle outflow tract/aortic valve growth (14 patients) or left ventricle growth (13 patients).
- Interstage management included reinterventions and reoperations; subsequent biventricular repair procedures varied.
Main Results:
- 85.2% of patients (23/27) survived at a median follow-up of 3.3 years.
- Significant growth in left ventricle parameters was observed during the interstage period (median 62 days).
- There were 22 reinterventions and 15 reoperations after biventricular repair.
Conclusions:
- Hybrid palliation can stimulate left heart growth in select infants with left ventricle hypoplasia.
- Biventricular circulation may be achievable in more patients than initially anticipated.
- Ongoing monitoring and potential interventions are crucial due to the risk of restrictive physiology in some patients.
Objectives:
We evaluated the outcomes of biventricular repair after initial hybrid palliation performed in small infants with various forms of left ventricle hypoplasia.
Methods:
Between September 2010 and January 2020, a total of 27 patients had biventricular repair after hybrid palliation at a median age of 11 days. Indications for the hybrid approach included growth promotion of the left ventricle outflow tract and/or the aortic valve in 14 patients and that of the left ventricle in 13 patients. Seven reinterventions and 7 reoperations were performed during the interstage period. Significant growth of left ventricle parameters was noted during the median interstage period of 62 days. Sixteen subjects had aortic arch repair, ventricular septal defect closure and relief of subaortic stenosis; 5 patients had the Ross-Konno procedure; 5 patients underwent the Yasui procedure; and 1 patient had unbalanced atrioventricular septal defect and aortic arch repair.
Results:
Twenty-three patients (85.2%) are alive at a median follow-up of 3.3 years. Two and 3 patients died early and late after achieving biventricular circulation, respectively. There were 22 reinterventions and 15 reoperations after biventricular repair.
Conclusions:
Hybrid palliation can stimulate left heart growth in some patients with left ventricle hypoplasia. More patients may eventually achieve biventricular circulation than was initially thought. Additional interventions and operations are foreseeable. Despite ventricular rehabilitation, some patients with borderline left ventricles may develop restrictive physiology.
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