Hybrid therapy for hypoplastic left heart syndrome: Myth, alternative, or standard?
Abstract Objective This retrospective study presents our operative results, mortality, and morbidity with regard to pulmonary artery growth and reinterventions on the pulmonary artery and aortic arch, including key features of our institutional standards for the 3-stage hybrid palliation of patients...
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| creator | Yerebakan, Can, MD Valeske, Klaus, MD Elmontaser, Hatem, MD Yörüker, Uygar, MD Mueller, Matthias, MD Thul, Josef, MD Mann, Valesco, MD Latus, Heiner, MD Villanueva, Anika, BSc Hofmann, Karoline, MS Schranz, Dietmar, MD Akintuerk, Hakan, MD |
| description | Abstract Objective This retrospective study presents our operative results, mortality, and morbidity with regard to pulmonary artery growth and reinterventions on the pulmonary artery and aortic arch, including key features of our institutional standards for the 3-stage hybrid palliation of patients with hypoplastic left heart syndrome. Methods Between June 1998 and February 2015, 182 patients with hypoplastic left heart structures underwent the Giessen hybrid stage I procedure. Among these, 126 patients with hypoplastic left heart syndrome who received a univentricular palliation or heart transplantation were included in the main analysis. Median age and body weight of patients at hybrid stage I were 6 days (0-237) and 3.2 kg (1.2-7), respectively. Comprehensive stage II operation was performed at 4.5 months (2.9-39.5), and Fontan completion was established at 33.7 months (21.1-108.2). Operative and interstage mortality, morbidity, growth and reinterventions on the pulmonary arteries, and long-term operative results of the aortic arch reconstruction were assessed. Results Median follow-up time after Giessen hybrid stage I palliation was 4.6 years (0-16.8). Operative mortality at hybrid stage I, comprehensive stage II, and Fontan completion was 2.5%, 4.9%, and 0%, respectively. Cumulative interstage mortality was 14.2%. At 10 years, the probability of survival is 77.8%. Body weight ( |
| doi_str_mv | 10.1016/j.jtcvs.2015.10.066 |
| format | Article |
| fullrecord | <record><control><sourceid>proquest_cross</sourceid><recordid>TN_cdi_proquest_miscellaneous_1775161343</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><els_id>1_s2_0_S0022522315021297</els_id><sourcerecordid>1775161343</sourcerecordid><originalsourceid>FETCH-LOGICAL-c595t-73aa7ed6ccb97331fdc79ff659fa44ba2839ad2f3175e764effd1af3db558ba03</originalsourceid><addsrcrecordid>eNqFkV9rFDEUxYNY7Lb6CQTJow-dNX8myY6gIqW2QsWHKvgWMskNm3F2ZppkF-bbm3FrH3zp04XLOfdwfheh15SsKaHyXbfusj2kNSNUlM2aSPkMrShpVCU34tdztCKEsUowxk_RWUodIUQR2rxAp0wqUhMhVujuZm5jcDhvIZppxn6MeDtP49SblIPFPfiMt2BixmkeXBx38B5_m_P2Aps-QxxMDge4wMWWshmcie7TS3TiTZ_g1cM8Rz-_XP24vKluv19_vfx8W1nRiFwpbowCJ61tG8U59c6qxnspGm_qujVswxvjmOdUCVCyBu8dNZ67VohNawg_R2-Pd6c43u8hZb0LyULfmwHGfdJUKUEl5TUvUn6U2jimFMHrKYadibOmRC80daf_0tQLzWVZaBbXm4eAfbsD9-j5h68IPhwFUGoeAkSdbIDBggsRbNZuDE8EfPzPb_swBGv63zBD6sZ9AdyXJjoxTfTd8tDln1QQRlmh9gchf50q</addsrcrecordid><sourcetype>Aggregation Database</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>1775161343</pqid></control><display><type>article</type><title>Hybrid therapy for hypoplastic left heart syndrome: Myth, alternative, or standard?</title><source>MEDLINE</source><source>Elsevier ScienceDirect Journals</source><source>Elektronische Zeitschriftenbibliothek - Frei zugängliche E-Journals</source><creator>Yerebakan, Can, MD ; Valeske, Klaus, MD ; Elmontaser, Hatem, MD ; Yörüker, Uygar, MD ; Mueller, Matthias, MD ; Thul, Josef, MD ; Mann, Valesco, MD ; Latus, Heiner, MD ; Villanueva, Anika, BSc ; Hofmann, Karoline, MS ; Schranz, Dietmar, MD ; Akintuerk, Hakan, MD</creator><creatorcontrib>Yerebakan, Can, MD ; Valeske, Klaus, MD ; Elmontaser, Hatem, MD ; Yörüker, Uygar, MD ; Mueller, Matthias, MD ; Thul, Josef, MD ; Mann, Valesco, MD ; Latus, Heiner, MD ; Villanueva, Anika, BSc ; Hofmann, Karoline, MS ; Schranz, Dietmar, MD ; Akintuerk, Hakan, MD</creatorcontrib><description>Abstract Objective This retrospective study presents our operative results, mortality, and morbidity with regard to pulmonary artery growth and reinterventions on the pulmonary artery and aortic arch, including key features of our institutional standards for the 3-stage hybrid palliation of patients with hypoplastic left heart syndrome. Methods Between June 1998 and February 2015, 182 patients with hypoplastic left heart structures underwent the Giessen hybrid stage I procedure. Among these, 126 patients with hypoplastic left heart syndrome who received a univentricular palliation or heart transplantation were included in the main analysis. Median age and body weight of patients at hybrid stage I were 6 days (0-237) and 3.2 kg (1.2-7), respectively. Comprehensive stage II operation was performed at 4.5 months (2.9-39.5), and Fontan completion was established at 33.7 months (21.1-108.2). Operative and interstage mortality, morbidity, growth and reinterventions on the pulmonary arteries, and long-term operative results of the aortic arch reconstruction were assessed. Results Median follow-up time after Giessen hybrid stage I palliation was 4.6 years (0-16.8). Operative mortality at hybrid stage I, comprehensive stage II, and Fontan completion was 2.5%, 4.9%, and 0%, respectively. Cumulative interstage mortality was 14.2%. At 10 years, the probability of survival is 77.8%. Body weight (<2.5 kg) and aortic atresia had no significant impact on survival. McGoon ratio did not differ at comprehensive stage II and Fontan completion ( P = .991). Freedom from pulmonary artery intervention was estimated to be 32.2% at 10 years. Aortic arch reinterventions were needed in 16.7% of patients; 2 reoperations on the aortic arch were necessary. Conclusions In view of the early results and long-term outcome, the hybrid approach has become an alternative to the conventional strategy to treat neonates with hypoplastic left heart syndrome and variants. Further refinements are warranted to decrease patient morbidity.</description><identifier>ISSN: 0022-5223</identifier><identifier>EISSN: 1097-685X</identifier><identifier>DOI: 10.1016/j.jtcvs.2015.10.066</identifier><identifier>PMID: 26704055</identifier><language>eng</language><publisher>United States: Elsevier Inc</publisher><subject>Adolescent ; Aorta, Thoracic - physiopathology ; Aorta, Thoracic - surgery ; Blood Vessel Prosthesis Implantation ; Cardiothoracic Surgery ; Child ; Child, Preschool ; Fontan Procedure - adverse effects ; Fontan Procedure - mortality ; Germany ; Humans ; hybrid treatment ; hypoplastic left heart syndrome ; Hypoplastic Left Heart Syndrome - diagnosis ; Hypoplastic Left Heart Syndrome - mortality ; Hypoplastic Left Heart Syndrome - physiopathology ; Hypoplastic Left Heart Syndrome - surgery ; Infant ; Kaplan-Meier Estimate ; Norwood Procedures - adverse effects ; Norwood Procedures - mortality ; outcome ; Palliative Care ; pulmonary arteries ; Pulmonary Artery - growth & development ; Pulmonary Artery - surgery ; Pulmonary Circulation ; reinterventions ; Reoperation ; Retrospective Studies ; Risk Factors ; survival ; Time Factors ; Treatment Outcome</subject><ispartof>The Journal of thoracic and cardiovascular surgery, 2016-04, Vol.151 (4), p.1112-1123.e5</ispartof><rights>The American Association for Thoracic Surgery</rights><rights>2016 The American Association for Thoracic Surgery</rights><rights>Copyright © 2016 The American Association for Thoracic Surgery. Published by Elsevier Inc. All rights reserved.</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c595t-73aa7ed6ccb97331fdc79ff659fa44ba2839ad2f3175e764effd1af3db558ba03</citedby><cites>FETCH-LOGICAL-c595t-73aa7ed6ccb97331fdc79ff659fa44ba2839ad2f3175e764effd1af3db558ba03</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktohtml>$$Uhttps://www.sciencedirect.com/science/article/pii/S0022522315021297$$EHTML$$P50$$Gelsevier$$Hfree_for_read</linktohtml><link.rule.ids>314,776,780,3537,27901,27902,65306</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/26704055$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Yerebakan, Can, MD</creatorcontrib><creatorcontrib>Valeske, Klaus, MD</creatorcontrib><creatorcontrib>Elmontaser, Hatem, MD</creatorcontrib><creatorcontrib>Yörüker, Uygar, MD</creatorcontrib><creatorcontrib>Mueller, Matthias, MD</creatorcontrib><creatorcontrib>Thul, Josef, MD</creatorcontrib><creatorcontrib>Mann, Valesco, MD</creatorcontrib><creatorcontrib>Latus, Heiner, MD</creatorcontrib><creatorcontrib>Villanueva, Anika, BSc</creatorcontrib><creatorcontrib>Hofmann, Karoline, MS</creatorcontrib><creatorcontrib>Schranz, Dietmar, MD</creatorcontrib><creatorcontrib>Akintuerk, Hakan, MD</creatorcontrib><title>Hybrid therapy for hypoplastic left heart syndrome: Myth, alternative, or standard?</title><title>The Journal of thoracic and cardiovascular surgery</title><addtitle>J Thorac Cardiovasc Surg</addtitle><description>Abstract Objective This retrospective study presents our operative results, mortality, and morbidity with regard to pulmonary artery growth and reinterventions on the pulmonary artery and aortic arch, including key features of our institutional standards for the 3-stage hybrid palliation of patients with hypoplastic left heart syndrome. Methods Between June 1998 and February 2015, 182 patients with hypoplastic left heart structures underwent the Giessen hybrid stage I procedure. Among these, 126 patients with hypoplastic left heart syndrome who received a univentricular palliation or heart transplantation were included in the main analysis. Median age and body weight of patients at hybrid stage I were 6 days (0-237) and 3.2 kg (1.2-7), respectively. Comprehensive stage II operation was performed at 4.5 months (2.9-39.5), and Fontan completion was established at 33.7 months (21.1-108.2). Operative and interstage mortality, morbidity, growth and reinterventions on the pulmonary arteries, and long-term operative results of the aortic arch reconstruction were assessed. Results Median follow-up time after Giessen hybrid stage I palliation was 4.6 years (0-16.8). Operative mortality at hybrid stage I, comprehensive stage II, and Fontan completion was 2.5%, 4.9%, and 0%, respectively. Cumulative interstage mortality was 14.2%. At 10 years, the probability of survival is 77.8%. Body weight (<2.5 kg) and aortic atresia had no significant impact on survival. McGoon ratio did not differ at comprehensive stage II and Fontan completion ( P = .991). Freedom from pulmonary artery intervention was estimated to be 32.2% at 10 years. Aortic arch reinterventions were needed in 16.7% of patients; 2 reoperations on the aortic arch were necessary. Conclusions In view of the early results and long-term outcome, the hybrid approach has become an alternative to the conventional strategy to treat neonates with hypoplastic left heart syndrome and variants. Further refinements are warranted to decrease patient morbidity.</description><subject>Adolescent</subject><subject>Aorta, Thoracic - physiopathology</subject><subject>Aorta, Thoracic - surgery</subject><subject>Blood Vessel Prosthesis Implantation</subject><subject>Cardiothoracic Surgery</subject><subject>Child</subject><subject>Child, Preschool</subject><subject>Fontan Procedure - adverse effects</subject><subject>Fontan Procedure - mortality</subject><subject>Germany</subject><subject>Humans</subject><subject>hybrid treatment</subject><subject>hypoplastic left heart syndrome</subject><subject>Hypoplastic Left Heart Syndrome - diagnosis</subject><subject>Hypoplastic Left Heart Syndrome - mortality</subject><subject>Hypoplastic Left Heart Syndrome - physiopathology</subject><subject>Hypoplastic Left Heart Syndrome - surgery</subject><subject>Infant</subject><subject>Kaplan-Meier Estimate</subject><subject>Norwood Procedures - adverse effects</subject><subject>Norwood Procedures - mortality</subject><subject>outcome</subject><subject>Palliative Care</subject><subject>pulmonary arteries</subject><subject>Pulmonary Artery - growth & development</subject><subject>Pulmonary Artery - surgery</subject><subject>Pulmonary Circulation</subject><subject>reinterventions</subject><subject>Reoperation</subject><subject>Retrospective Studies</subject><subject>Risk Factors</subject><subject>survival</subject><subject>Time Factors</subject><subject>Treatment Outcome</subject><issn>0022-5223</issn><issn>1097-685X</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2016</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNqFkV9rFDEUxYNY7Lb6CQTJow-dNX8myY6gIqW2QsWHKvgWMskNm3F2ZppkF-bbm3FrH3zp04XLOfdwfheh15SsKaHyXbfusj2kNSNUlM2aSPkMrShpVCU34tdztCKEsUowxk_RWUodIUQR2rxAp0wqUhMhVujuZm5jcDhvIZppxn6MeDtP49SblIPFPfiMt2BixmkeXBx38B5_m_P2Aps-QxxMDge4wMWWshmcie7TS3TiTZ_g1cM8Rz-_XP24vKluv19_vfx8W1nRiFwpbowCJ61tG8U59c6qxnspGm_qujVswxvjmOdUCVCyBu8dNZ67VohNawg_R2-Pd6c43u8hZb0LyULfmwHGfdJUKUEl5TUvUn6U2jimFMHrKYadibOmRC80daf_0tQLzWVZaBbXm4eAfbsD9-j5h68IPhwFUGoeAkSdbIDBggsRbNZuDE8EfPzPb_swBGv63zBD6sZ9AdyXJjoxTfTd8tDln1QQRlmh9gchf50q</recordid><startdate>20160401</startdate><enddate>20160401</enddate><creator>Yerebakan, Can, MD</creator><creator>Valeske, Klaus, MD</creator><creator>Elmontaser, Hatem, MD</creator><creator>Yörüker, Uygar, MD</creator><creator>Mueller, Matthias, MD</creator><creator>Thul, Josef, MD</creator><creator>Mann, Valesco, MD</creator><creator>Latus, Heiner, MD</creator><creator>Villanueva, Anika, BSc</creator><creator>Hofmann, Karoline, MS</creator><creator>Schranz, Dietmar, MD</creator><creator>Akintuerk, Hakan, MD</creator><general>Elsevier Inc</general><scope>6I.</scope><scope>AAFTH</scope><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope></search><sort><creationdate>20160401</creationdate><title>Hybrid therapy for hypoplastic left heart syndrome: Myth, alternative, or standard?</title><author>Yerebakan, Can, MD ; Valeske, Klaus, MD ; Elmontaser, Hatem, MD ; Yörüker, Uygar, MD ; Mueller, Matthias, MD ; Thul, Josef, MD ; Mann, Valesco, MD ; Latus, Heiner, MD ; Villanueva, Anika, BSc ; Hofmann, Karoline, MS ; Schranz, Dietmar, MD ; Akintuerk, Hakan, MD</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c595t-73aa7ed6ccb97331fdc79ff659fa44ba2839ad2f3175e764effd1af3db558ba03</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2016</creationdate><topic>Adolescent</topic><topic>Aorta, Thoracic - physiopathology</topic><topic>Aorta, Thoracic - surgery</topic><topic>Blood Vessel Prosthesis Implantation</topic><topic>Cardiothoracic Surgery</topic><topic>Child</topic><topic>Child, Preschool</topic><topic>Fontan Procedure - adverse effects</topic><topic>Fontan Procedure - mortality</topic><topic>Germany</topic><topic>Humans</topic><topic>hybrid treatment</topic><topic>hypoplastic left heart syndrome</topic><topic>Hypoplastic Left Heart Syndrome - diagnosis</topic><topic>Hypoplastic Left Heart Syndrome - mortality</topic><topic>Hypoplastic Left Heart Syndrome - physiopathology</topic><topic>Hypoplastic Left Heart Syndrome - surgery</topic><topic>Infant</topic><topic>Kaplan-Meier Estimate</topic><topic>Norwood Procedures - adverse effects</topic><topic>Norwood Procedures - mortality</topic><topic>outcome</topic><topic>Palliative Care</topic><topic>pulmonary arteries</topic><topic>Pulmonary Artery - growth & development</topic><topic>Pulmonary Artery - surgery</topic><topic>Pulmonary Circulation</topic><topic>reinterventions</topic><topic>Reoperation</topic><topic>Retrospective Studies</topic><topic>Risk Factors</topic><topic>survival</topic><topic>Time Factors</topic><topic>Treatment Outcome</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Yerebakan, Can, MD</creatorcontrib><creatorcontrib>Valeske, Klaus, MD</creatorcontrib><creatorcontrib>Elmontaser, Hatem, MD</creatorcontrib><creatorcontrib>Yörüker, Uygar, MD</creatorcontrib><creatorcontrib>Mueller, Matthias, MD</creatorcontrib><creatorcontrib>Thul, Josef, MD</creatorcontrib><creatorcontrib>Mann, Valesco, MD</creatorcontrib><creatorcontrib>Latus, Heiner, MD</creatorcontrib><creatorcontrib>Villanueva, Anika, BSc</creatorcontrib><creatorcontrib>Hofmann, Karoline, MS</creatorcontrib><creatorcontrib>Schranz, Dietmar, MD</creatorcontrib><creatorcontrib>Akintuerk, Hakan, MD</creatorcontrib><collection>ScienceDirect Open Access Titles</collection><collection>Elsevier:ScienceDirect:Open Access</collection><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><jtitle>The Journal of thoracic and cardiovascular surgery</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Yerebakan, Can, MD</au><au>Valeske, Klaus, MD</au><au>Elmontaser, Hatem, MD</au><au>Yörüker, Uygar, MD</au><au>Mueller, Matthias, MD</au><au>Thul, Josef, MD</au><au>Mann, Valesco, MD</au><au>Latus, Heiner, MD</au><au>Villanueva, Anika, BSc</au><au>Hofmann, Karoline, MS</au><au>Schranz, Dietmar, MD</au><au>Akintuerk, Hakan, MD</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Hybrid therapy for hypoplastic left heart syndrome: Myth, alternative, or standard?</atitle><jtitle>The Journal of thoracic and cardiovascular surgery</jtitle><addtitle>J Thorac Cardiovasc Surg</addtitle><date>2016-04-01</date><risdate>2016</risdate><volume>151</volume><issue>4</issue><spage>1112</spage><epage>1123.e5</epage><pages>1112-1123.e5</pages><issn>0022-5223</issn><eissn>1097-685X</eissn><abstract>Abstract Objective This retrospective study presents our operative results, mortality, and morbidity with regard to pulmonary artery growth and reinterventions on the pulmonary artery and aortic arch, including key features of our institutional standards for the 3-stage hybrid palliation of patients with hypoplastic left heart syndrome. Methods Between June 1998 and February 2015, 182 patients with hypoplastic left heart structures underwent the Giessen hybrid stage I procedure. Among these, 126 patients with hypoplastic left heart syndrome who received a univentricular palliation or heart transplantation were included in the main analysis. Median age and body weight of patients at hybrid stage I were 6 days (0-237) and 3.2 kg (1.2-7), respectively. Comprehensive stage II operation was performed at 4.5 months (2.9-39.5), and Fontan completion was established at 33.7 months (21.1-108.2). Operative and interstage mortality, morbidity, growth and reinterventions on the pulmonary arteries, and long-term operative results of the aortic arch reconstruction were assessed. Results Median follow-up time after Giessen hybrid stage I palliation was 4.6 years (0-16.8). Operative mortality at hybrid stage I, comprehensive stage II, and Fontan completion was 2.5%, 4.9%, and 0%, respectively. Cumulative interstage mortality was 14.2%. At 10 years, the probability of survival is 77.8%. Body weight (<2.5 kg) and aortic atresia had no significant impact on survival. McGoon ratio did not differ at comprehensive stage II and Fontan completion ( P = .991). Freedom from pulmonary artery intervention was estimated to be 32.2% at 10 years. Aortic arch reinterventions were needed in 16.7% of patients; 2 reoperations on the aortic arch were necessary. Conclusions In view of the early results and long-term outcome, the hybrid approach has become an alternative to the conventional strategy to treat neonates with hypoplastic left heart syndrome and variants. Further refinements are warranted to decrease patient morbidity.</abstract><cop>United States</cop><pub>Elsevier Inc</pub><pmid>26704055</pmid><doi>10.1016/j.jtcvs.2015.10.066</doi><tpages>10</tpages><oa>free_for_read</oa></addata></record> |
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| subjects | Adolescent Aorta, Thoracic - physiopathology Aorta, Thoracic - surgery Blood Vessel Prosthesis Implantation Cardiothoracic Surgery Child Child, Preschool Fontan Procedure - adverse effects Fontan Procedure - mortality Germany Humans hybrid treatment hypoplastic left heart syndrome Hypoplastic Left Heart Syndrome - diagnosis Hypoplastic Left Heart Syndrome - mortality Hypoplastic Left Heart Syndrome - physiopathology Hypoplastic Left Heart Syndrome - surgery Infant Kaplan-Meier Estimate Norwood Procedures - adverse effects Norwood Procedures - mortality outcome Palliative Care pulmonary arteries Pulmonary Artery - growth & development Pulmonary Artery - surgery Pulmonary Circulation reinterventions Reoperation Retrospective Studies Risk Factors survival Time Factors Treatment Outcome |
| title | Hybrid therapy for hypoplastic left heart syndrome: Myth, alternative, or standard? |
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