Bleiweis MS, Philip J, Peek GJ, Fudge JC, Sullivan KJ, Co-Vu J, Gupta D, Fricker FJ, Vyas HV, Ebraheem M, Powers ER, Falasa M, Jacobs JP. Combined Hybrid Procedure and VAD insertion in 9 High-Risk Neonates and Infants with HLHS.
Ann Thorac Surg 2021;
114:809-816. [PMID:
34186096 DOI:
10.1016/j.athoracsur.2021.05.073]
[Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2021] [Revised: 04/13/2021] [Accepted: 05/10/2021] [Indexed: 11/01/2022]
Abstract
BACKGROUND
We report nine high-risk neonates and infants with HLHS stabilized with a Hybrid Approach + VAD insertion (Hybrid+VAD) in preparation for transplantation.
METHODS
Nine patients with HLHS (7 neonates, 2 infants) presented with anatomical and/or physiological features associated with increased risk for conventional univentricular palliation with the Norwood Operation (large coronary sinusoids/fistulas, severe tricuspid regurgitation, cardiogenic shock, restrictive atrial septum). These patients underwent combined VAD insertion (Berlin EXCOR) and stage 1 hybrid palliation (application of bilateral pulmonary bands, stent placement in the PDA, and atrial septectomy if needed). During this same era, at our institution, 41 neonates underwent Norwood Operation, three neonates underwent Hybrid Approach "Stage 1" without VAD, and three HLHS patients were supported with prostaglandin while awaiting transplantation.
RESULTS
At Hybrid+VAD insertion, median age = 20 days (range = 13-143) and median weight = 3.25 kilograms (range = 2.43-4.2). Six patients survive (67%) and three patients died (33%). Five survivors are at home doing well after successful transplantation and one survivor is doing well in the ICU on VAD support awaiting transplantation. Only one of six survivors (16.7%) required intubation more than 10 days after Hybrid+VAD insertion. In eight patients no longer on VAD, median length of VAD support was 119.5 days (range = 56-196 days).
CONCLUSIONS
High-risk patients with HLHS who are suboptimal candidates for Norwood palliation can be successfully stabilized with pulsatile VAD insertion along with hybrid palliation while awaiting cardiac transplantation; these patients may be extubated and optimized for transplantation while on VAD.
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