Interstage Reinterventions in Hybrid Stage I Palliation - Impact on Survival to Comprehensive Stage II Operation
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Published on: February 12, 2017
Joseph Wride1, Amee M Bigelow2, Lydia K Wright2
1The Ohio State University College of Medicine, Columbus, OH.
Objective:
The need for interstage reinterventions is one of the perceived limitations of Hybrid Stage 1 Palliation (HS1P). We aim to evaluate the impact of unplanned interstage reinterventions on survival to comprehensive stage II (CS2) and characterize their frequency, type, and timing.
Methods:
We retrospectively reviewed 199 infants who underwent HS1P at a single institution from 2009 to 2025, tracking all reinterventions between HS1P and CS2. We assessed the likelihood of reaching CS2 using a series of Fine-Gray models at distinct landmarks to assess competing risks, comparing reintervention and non-reintervention groups.
Results:
The reintervention rate in our study was 43%, with 132 unique reinterventions received in 86 patients. In the reintervention group, progression to CS2 was 78%, with 4.7% of patients dying after HS1P. Among the 33 patients (17%) who died after HS1P, 88% did not receive reinterventions and 76% died prior to HS1P discharge. Reinterventions before 90 days post-HS1P were associated with no difference in progression to CS2 (sHR 1.20, CI 0.83-1.74), but reinterventions before 150 days post-HS1P were associated with a decreased likelihood of reaching CS2 (sHR 0.61, CI 0.41-0.93). The most common reintervention target was the retrograde aortic arch (45%), with aortic atresia in 72% of these patients.
Conclusions:
Interstage reinterventions after HS1P are common, but, if done early, do not appear to worsen survival to comprehensive stage II. Reinterventions play an integral part of HS1P care rather than a marker of failure, especially when performed early.