Original articlePediatric cardiacClinical Outcomes, Program Evolution, and Pulmonary Artery Growth in Single Ventricle Palliation Using Hybrid and Norwood Palliative Strategies
Section snippets
Patients and Methods
We conducted a retrospective study of the patients with HLHS or its variants who underwent staged single ventricle palliation between January 2004 and December 2007. The Research Ethics Board at the Hospital for Sick Children approved this retrospective study, and patient consent was waived. Seventy-six consecutive patients with HLHS and its variants had been treated at the Hospital for Sick Children. The patients who underwent stage 1 palliation with a right ventricle to PA shunt (n = 10) or
Results
There were no significant differences in age and body weight at stage 1 palliation between groups (p = nonsignificant; Table 1,). There were 4 operative or interim deaths (21%) in the hybrid group, and 8 operative or interim deaths (20.5%) in the Norwood group (Fig 1). Four patients (10.4%) in the Norwood group underwent heart transplantation after stage 1 palliation for progressive ventricular failure: 2 patients underwent transplantation during the early interim stage, and the remaining 2
Comment
Hybrid palliation has evolved as an alternative to Norwood palliation based on an unproven assumption that the less invasive stage 1 palliation in the hybrid strategy would improve overall survival. In the present study, comparison of a nonrandomized concurrent cohort of patients undergoing Norwood and hybrid palliation, there was no measurable difference in survival.
Another important measure of a palliative strategy is the promotion of PA growth to create better Fontan candidates. Potential
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2021, Annals of Thoracic SurgeryCitation Excerpt :Although it is impossible to draw conclusions from a lack of statistical significance in a small patient size such as this, we report that smaller RV-PA conduits during stage 1 SV palliation did not require a higher rate of PA plasty at stage 2. Nonetheless, continued systematic assessment of PA growth is essential, because this can potentially affect eligibility for Fontan candidates as well as subsequent outcomes.4 Results of various studies including the SVR trial have shown the stability in postoperative hemodynamics of an RV-PA shunt after stage 1 palliation in SV patients.5