Outcomes After Hybrid Palliation for Infants With Critical Left Heart Obstruction.
Обработка статьи · этапы, ошибки и управление
Ошибки и ограничения
История · было → стало
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Argo Madison B, Barron David J, Eghtesady Pirooz, Yerebakan Can, DeCampli Williams M, Alsoufi Bahaaldin, Honjo Osami, Jacobs Jeffrey P, Paramananthan Tharini, Rahman Maha, Lambert Linda M, Jegatheeswaran Anusha, Carrillo Sergio A, Husain S Adil, Ramakrishnan Karthik, Caldarone Christopher A, Karamlou Tara, Nelson Jennifer, Mannie Chelsea, Romano Jennifer C, Turek Joseph W, Blackstone Eugene H, Galantowicz Mark E, Kirklin James K, Mitchell Michael E, McCrindle Brian W, Congenital Heart Surgeons Society Critical Left Heart Obstruction Work Group
Аннотация
OBJECTIVES: This study sought to determine patient characteristics and factors associated with subsequent outcomes for infants who underwent hybrid palliation.
METHODS: From 2005 to 2019, 214 of 1,236 prospectively enrolled infants within the Congenital Heart Surgeons' Society's critical left heart obstruction cohort underwent hybrid palliation across 24 institutions. Multivariable hazard modeling with competing risk methodology was performed to determine risk and factors associated with outcomes of biventricular repair, Fontan procedure, transplantation, or death.
RESULTS: Preoperative comorbidities (eg, prematurity, low birth weight, genetic syndrome) were identified in 70% of infants (150 of 214). Median follow-up was 7 years, ranging up to 17 years. Overall 12-year survival was 55%. At 5 years after hybrid palliation, 9% had biventricular repair, 36% had Fontan procedure, 12% had transplantation, 35% died without surgical endpoints, and 8% were alive without an endpoint. Factors associated with transplantation were absence of ductal stent, older age, absent interatrial communication, smaller aortic root size, larger tricuspid valve area z-score, and larger left ventricular volume. Factors associated with death were low birth weight, concomitant genetic syndrome, cardiopulmonary bypass use during hybrid palliation, moderate to severe tricuspid valve regurgitation, and smaller ascending aortic size.
CONCLUSIONS: Mortality remains high after hybrid palliation for infants with critical left heart obstruction. Nonetheless, hybrid palliation may facilitate biventricular repair for some infants and for others may serve as stabilization for intended functional univentricular palliation or primary transplantation.