Fifteen-year Single Center Experience with the 'Giessen Hybrid' Approach for Hypoplastic Left Heart and Variants: Current Strategies and Outcomes
Autor: | Matthias J. Müller, Christian Apitz, B. Steinbrenner, Ina Michel-Behnke, Hakan Akintürk, Sabine Recla, Josef Thul, Dietmar Schranz, Dorle Schmidt, Klaus Valeske, Anna Bauer, Jürgen Bauer, Christian Jux, Bettina Reich |
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Rok vydání: | 2014 |
Předmět: |
medicine.medical_specialty
Pediatrics Percutaneous Hypoplastic left heart syndrome business.industry Retrospective cohort study Single Center medicine.disease Hybrid approach Surgery Cardiac surgery Pulmonary artery banding Transplantation Pediatrics Perinatology and Child Health Medicine Original Article Pediatrics Perinatology and Child Health Hypoplastic left heart complex Cardiology and Cardiovascular Medicine business Survival rate |
Zdroj: | Pediatric Cardiology |
ISSN: | 1432-1971 0172-0643 |
Popis: | Presented is a retrospective outcome study of a 15-year single institutional experience with a contemporary cohort of patients with hypoplastic left heart syndrome and complex that underwent a “Giessen Hybrid” stage I as initial palliation. Hybrid approach consisting of surgical bilateral pulmonary artery banding and percutaneous duct stenting with or without atrial septum manipulation was developed from a rescue approach to a first-line procedure. Comprehensive Aristotle score defined pre-operative condition. Fifteen-year follow-up mortality is reported as occurring within the staged univentricular palliation or before and after biventricular repair. Hybrid stage I was performed in 154 patients; 107 should be treated by single ventricle palliation, 33 by biventricular repair (BVR), 7 received heart transplantation, and 7 were treated by comfort care, respectively. Overall 34 children died. The Aristotle score (mean value 18.2 ± 3) classified for univentricular circulations in newborns did not have statistical impact on the outcome. Two patients died during stage I (1.2 %), and the interstage I mortality was 6.7 %, and stage II mortality 9 %, respectively. Stage III was up to now performed in 57 patients without mortality. At 1 year, the overall unadjusted survival of HLHS and variants was 84 % and following BVR 89 %, respectively. The Fifteen-year survival rate for HLHS and variants was 77 %, with no significant impact of birth weight of less than 2.5 kg. In conclusion, Hybrid stage I fulfilled the criteria of life-saving approach. In our institution, Hybrid procedure replaced Norwood-staged palliation with a considerable mid- and long-term survival rate. Considering interstage mortality close surveillance is mandatory. |
Databáze: | OpenAIRE |
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