Outcomes Of Univentricular Palliation After Initial Bilateral Pulmonary Artery Banding In Infants With Critical Left Heart Obstruction: An Analysis Of The CHSS LVOTO Cohort
Madison B. Argo, MD1, Pirooz Eghtesady, MD, PhD2, David J. Barron, MD1, Hani K. Najm, MD, MSc3, Bahaaldin Alsoufi, MD4, Christopher A. Caldarone, MD5, Sergio A. Carrillo, MD6, William M. DeCampli, MD, PhD7, Mark Galantowicz, MD6, Osami Honjo, MD, PhD1, S. Adil Husain, MD8, Jeffrey P. Jacobs, MD9, Anusha Jegatheeswaran, MD, PhD10, Tara Karamlou, MD, MSc3, James K. Kirklin, MD11, Linda Lambert, MSN-cFNP8, Michael E. Mitchell, MD12, Jennifer Nelson, CCRC13, Tharini Paramananthan, RN, MScN1, Maha Rahman, BSc1, Karthik Ramakrishnan, MD14, Jennifer C. Romano, MD, MS15, Joseph W. Turek, MD, PhD16, Can Yerebakan, MD17, Brian W. McCrindle, MD, MPH1.
1Hospital for Sick Children, Toronto, ON, Canada, 2Washington University, St. Louis, MO, USA, 3The Cleveland Clinic, Cleveland, OH, USA, 4University of Louisville, Louisville, KY, USA, 5Texas Children's Hospital, Houston, TX, USA, 6Nationwide Children's Hospital, Columbus, OH, USA, 7Arnold Palmer Hospital for Children, Orlando, FL, USA, 8Primary Children's Hospital, Salt Lake City, UT, USA, 9University of Florida Health Sciences Center, Gainesville, FL, USA, 10Great Ormond Street Hospital for Children, London, United Kingdom, 11University of Alabama at Birmingham, Birmingham, AL, USA, 12Children's Hospital Wisconsin, Milwaukee, WI, USA, 13Children's Mercy Kansas City, Kansas City, MO, USA, 14University of Tennessee Health Science Center, Memphis, TN, USA, 15Mott Children's Hospital, Ann Arbor, MI, USA, 16Duke University Medical Center, Durham, NC, USA, 17Children's National Hospital, Washington, DC, USA.
Objective(s): To describe the characteristics and outcomes of patients undergoing univentricular palliation after initial hybrid procedure (placement of bilateral pulmonary artery bands ± ductal stent) with delayed Norwood (NW) or comprehensive stage II (COMPSII) in a multi-institutional cohort of infants with critical left heart obstruction (LVOTO).
Methods: A group of 138 infants from 23 institutions in the Congenital Heart Surgeons' Society (CHSS) LVOTO cohort (2005-2020) received the hybrid procedure and survived to begin subsequent univentricular palliation. Competing risk methodology was used to describe time-related risk of death, Fontan, and transplantation after NW (n=73; 53%) and COMPSII (n=65).
Results: Median follow-up was 6.5 years. Norwood patients had more prematurity (26% vs 14%, p=0.08) and lower birth weight (median 2.8 vs 3.2 kg, p<0.01). Ductal stenting occurred in 37% and 99% (p<0.01) of NW and COMPSII patients, respectively. Norwood was performed at a median age of 44 days and 3.5 kg and COMPSII at 162 days and 6.0 kg. The proportion of outcomes 5 years after NW and COMPSII, respectively, were: Fontan 45% and 65%; transplantation 3% and 5%; death 39% and 18%; and alive without transition 14% and 13% (Figure 1).
Conclusions: After initial hybrid procedure, infants who undergo NW have different underlying characteristics compared to infants who undergo a COMPSII. These differences may direct their surgical pathway and ultimately influence outcomes.
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