Outcomes After Hybrid Palliation for Infants With Critical Left Heart Obstruction
Authors' conclusion
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.
Study context
- Population
- Infants with critical left heart obstruction undergoing hybrid palliation (bilateral pulmonary artery banding ± ductal stenting), Congenital Heart Surgeons' Society cohort, 2005–2019of 1,236 in cohort
- Participants
- 214 infants
- Outcome
- Biventricular repair, Fontan procedure, transplantation or death, and associated factors
Methodological detailsprospectively enrolled, 24 institutions, competing risk analysis
- Prospectively enrolled
- 24 institutions
- Competing risk analysis
Main finding
As reported in the abstract
Outcomes after hybrid palliation · 5 years
- Biventricular repair
- 9%
- Fontan procedure
- 36%
- Transplantation
- 12%
- Died without surgical endpoints
- 35%
- Alive without an endpoint
- 8%
Observational data: associations, not effects.
Further findings
Overall survival · 12 years
- Overall 12-year survival
- 55%
- Median follow-up 7 years, up to 17 years
Preoperative comorbidities (eg, prematurity, low birth weight, genetic syndrome)
- Infants with preoperative comorbidities
- 70% (150 of 214)
Factors associated with transplantation
- Absence of ductal stent, older age, absent interatrial communication, smaller aortic root size, larger tricuspid valve area z-score, larger LV volume
Factors associated with death
- Low birth weight, concomitant genetic syndrome, cardiopulmonary bypass use during hybrid palliation, moderate to severe tricuspid valve regurgitation, smaller ascending aortic size
Original publication
Outcomes After Hybrid Palliation for Infants With Critical Left Heart Obstruction. J Am Coll Cardiol. Published 3 October 2023. doi:10.
Summarised from the published abstract; every number is checked against it