Surgical, Hybrid, or Delayed Surgical Stage 1: Single-Ventricle Palliation Pathway Utilization and Outcome Trends

Area of Science:

• Pediatric Cardiology
• Congenital Heart Surgery
• Neonatal Intensive Care

Background:

• Single-ventricle palliation involves complex surgical or hybrid approaches.
• Traditional surgical stage 1 palliation (SP), hybrid stage 1 palliation (HP), and delayed surgical stage 1 palliation (DSP) are current strategies.
• Conflicting data exists regarding the optimal pathway for single-ventricle palliation.

Purpose of the Study:

• To analyze current utilization patterns of single-ventricle palliation pathways.
• To compare outcomes associated with SP, HP, and DSP.
• To identify patient characteristics influencing pathway selection.

Main Methods:

• Retrospective analysis of 1872 patients undergoing single-ventricle palliation from January 2016 to August 2023.
• Utilized the Pediatric Health Information System database.
• Compared outcomes including mortality, transplant rates, length of stay, and costs across SP, DSP, and HP groups.

Main Results:

• Delayed surgical palliation (DSP) was more common in premature infants and those with low birth weight or comorbidities.
• Hybrid palliation (HP) demonstrated the highest in-hospital mortality (25.6%) and transplant rates (8.5%).
• DSP was associated with the longest hospital and ICU stays, while costs per day did not differ significantly.

Conclusions:

• Delayed surgical palliation (DSP) is utilized for higher-risk neonates.
• Hybrid palliation (HP) is linked to increased in-hospital mortality and transplant rates.
• Further research is needed to establish the benefits of DSP for high-risk populations.