Hybrid versus norwood strategies for single-ventricle palliation

Kenji Baba, Yasuhiro Kotani, Devin Chetan, Rajiv R. Chaturvedi, Kyong Jin Lee, Lee N. Benson, Lars Grosse-Wortmann, Glen S. Van Arsdell, Christopher A. Caldarone, Osami Honjo

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65 Citations (Scopus)

Abstract

Background-Hybrid and Norwood strategies differ substantially in terms of stage II palliative procedures. We sought to compare these strategies with an emphasis on survival and reintervention after stage II and subsequent Fontan completion. Methods and Results-Of 110 neonates with functionally single-ventricle physiology who underwent stage I palliation between 2004 and 2010, 75 (69%) infants (Norwood, n=43; hybrid, n=32) who subsequently underwent stage II palliation were studied. Survival and reintervention rates after stage II palliation, anatomic and physiologic variables at pre-Fontan assessment, and Fontan outcomes were compared between the groups. Predictors for reintervention were analyzed. Freedom from death/transplant after stage II palliation was equivalent between the groups (Norwood, 80.4% versus hybrid, 85.6% at 3 years, P=0.66). Hybrid patients had a higher pulmonary artery (PA) reintervention rate (P=0.003) and lower Nakata index at pre-Fontan evaluation (P=0.015). Aortic arch and atrioventricular valve reinterventions were not different between the groups. Ventricular end-diastolic pressure, mean PA pressure, and ventricular function were equivalent at pre-Fontan assessment. There were no deaths after Fontan completion in either group (Norwood, n=25, hybrid, n=14). Conclusions-Survival after stage II palliation and subsequent Fontan completion is equivalent between the groups. The hybrid group had a higher PA reintervention rate and smaller PA size. Both strategies achieved adequate physiology for Fontan completion. Evolution of the hybrid strategy requires refinement to provide optimal PA growth.

Original languageEnglish
JournalCirculation
Volume126
Issue number11 SUPPL.1
DOIs
Publication statusPublished - Sep 11 2012
Externally publishedYes

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Keywords

  • hybrid
  • hypoplastic left heart syndrome
  • Norwood
  • pulmonary artery
  • single ventricle

ASJC Scopus subject areas

  • Physiology (medical)
  • Cardiology and Cardiovascular Medicine

Cite this

Baba, K., Kotani, Y., Chetan, D., Chaturvedi, R. R., Lee, K. J., Benson, L. N., Grosse-Wortmann, L., Van Arsdell, G. S., Caldarone, C. A., & Honjo, O. (2012). Hybrid versus norwood strategies for single-ventricle palliation. Circulation, 126(11 SUPPL.1). https://doi.org/10.1161/CIRCULATIONAHA.111.084616