Hybrid Versus Percutaneous Left Atrial Decompression in Infants With Hypoplastic Left Heart Variants and an Intact or Highly Restrictive Atrial Septum: A Multicenter PICES Study
Authors' conclusion
In patients with HLH-IAS, hybrid LAD allows for faster atrial septal defect creation, has a higher technical success rate, and potentially fewer procedural serious adverse events compared with percutaneous LAD, alongside facilitating simultaneous pulmonary artery band. Our findings underscore the poor prognosis for patients with HLH-IAS despite intervention, highlighting the need for better treatment strategies.
Study context
- Population
- Neonates with hypoplastic left heart syndrome variants with an intact or highly restrictive atrial septum (HLH-IAS) who underwent left atrial decompression (LAD) in the first 36 hours of lifepatients with HLH-IAS
- Participants
- 128 neonates
- Exposure
- Hybrid and percutaneous LAD
- Percutaneous LADn = 105
- Hybrid LADn = 23
- Outcome
- Preprocedural characteristics
Methodological details14 North American congenital cardiac programs, January 2009 to March 2020
- 14 North American congenital cardiac programs
- January 2009 to March 2020
Main finding
As reported in the abstract
Baseline interatrial communication
| Outcome | Percutaneous LAD | Hybrid LAD |
|---|---|---|
| Birth weight | 3.1±0.6 kg | 3.2±0.6 kg |
| Interatrial communication gradient | 14.4±6.9 mm Hg | 12.7±4.6 mm Hg |
| Lowest pH | 7.13±0.14 | 7.09±0.15 |
Observational data: associations, not effects.
Further findings
Time from birth to procedure · shorter with hybrid LAD
P = 0.005
Time from birth to atrial septal defect creation · shorter with hybrid LAD
P = 0.002
| Outcome | Percutaneous LAD | Hybrid LAD |
|---|---|---|
| Technical success | unsuccessful 10% | All technically successful |
| Pulmonary artery band | required reoperation for pulmonary artery band 21% | simultaneous pulmonary artery band placement 67% |
- Technical success — of the 11 unsuccessful percutaneous LAD, requiring conversion to surgical septectomy
- 7
Transplant-free survival · median 8-month follow-up
- Transplant-free survival, comparably low between groups
- 30%
Safety
Serious adverse events · trend toward fewer with hybrid LAD
P = 0.141
Original publication
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