Use and outcomes of the medical hybrid procedure for stage 1 palliation in infants with hypoplastic left heart syndrome and variants

Abstract

Background: Staged palliation of hypoplastic left heart syndrome and variants begins with the Norwood or hybrid procedure. Hybrid palliation is used in a minority of cases and often reserved for high-risk patients. Stented hybrid (SH) comprises bilateral pulmonary artery bands and ductal stenting, and medical hybrid (MH) comprises bilateral pulmonary artery bands and prostaglandins. MH use and outcomes have not been well described. We sought to compare MH, SH, and surgical stage 1 (SS1) using a national database.

Methods: Patients from the National Pediatric Cardiology Quality Improvement Collaborative database born between 2016 and 2021 were categorized by initial intervention: MH, SH, or SS1. Statistical comparisons and Kaplan-Meier analysis were performed.

Results: This study included 2423 patients from 65 centers: 277 (11%) MH, 133 (5%) SH, and 2013 (83%) SS1. MH had lowest birth weight and gestational age, most noncardiac anomalies, and most preoperative risk factors. Most centers had minority MH, though use ranged from 0% to 82% at centers with ≥10 patients. Transplant-free 1-year survival was MH 56%, SH 66%, and SS1 81% (P<0.0001). Using multivariable logistic regression, predictors of MH versus SS1 were lower birth weight, lower gestational age, genetic syndrome, noncardiac anomaly, and ≥4/12 preoperative risk factors. Predictors of MH versus SH were hypoplastic left heart syndrome and ≥4/12 preoperative risk factors. Cox proportional hazards regression showed MH had higher adjusted risk of 1-year mortality/transplant compared with SS1 (hazard ratio [HR], 1.86 [95% CI, 1.44-2.39]) and no difference compared with SH (HR, 1.20 [95% CI, 0.84-1.70]).

Conclusions: Survival after MH is similar to SH and worse than SS1. This may be due to patient risk factors not controlled for in this study.

Type

Article

PubMed ID

41168943

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