Article Impact Level: HIGH Data Quality: STRONG Summary of Journal of the American College of Cardiology, 82(14), 1427–1441. https://doi.org/10.1016/j.jacc.2023.07.020 Dr. Madison B. Argo et al.
Points
- Hybrid palliation, involving pulmonary artery banding and ductal stenting, is employed as an initial intervention for infants with critical left heart obstruction, serving as a temporary measure until further surgical procedures are possible.
- A research study from 2005 to 2019, including 214 infants from a larger cohort, assessed the patient characteristics and factors influencing outcomes after hybrid palliation.
- Preoperative comorbidities were common in 70% of infants, including prematurity, low birth weight, and genetic syndromes. The median follow-up period was extended to 7 years, with a 12-year survival rate of 55%.
- Five years after hybrid palliation, outcomes varied, with 9% achieving biventricular repair, 36% undergoing the Fontan procedure, 12% receiving transplantation, 35% experiencing mortality without surgical intervention, and 8% remaining alive without a surgical endpoint.
- Factors associated with transplantation included the absence of a ductal stent, older age, and specific cardiac anatomical features. In contrast, mortality-related factors included low birth weight, genetic syndromes, and cardiac surgical complications. The study highlights hybrid palliation’s challenges and potential benefits in infants with critical left heart obstruction.
Summary
This research paper discusses the utilization of hybrid palliation as an initial intervention for infants diagnosed with critical left heart obstruction, a life-threatening congenital heart condition. Hybrid palliation, which involves bilateral pulmonary artery banding with or without ductal stenting, is a temporary solution until subsequent surgical procedures can be pursued. The primary aim of this study was to investigate patient characteristics and identify factors influencing the long-term outcomes of infants who underwent this hybrid palliation approach.
Over a period spanning from 2005 to 2019, the study enrolled 214 infants out of a total of 1,236 prospectively recruited subjects within the Congenital Heart Surgeons’ Society’s cohort with critical left heart obstruction. The investigation took place across 24 different medical institutions. The research employed multivariable hazard modeling with competing risk methodology to assess the risk and various factors associated with potential outcomes, including biventricular repair, Fontan procedure, transplantation, or mortality.
The study’s results demonstrated that a significant proportion of infants subjected to hybrid palliation presented with preoperative comorbidities, including prematurity, low birth weight, and genetic syndromes, in approximately 70% of the cases and the median follow-up period extended to seven years, with a maximum of 17 years, revealing an overall 12-year survival rate of 55%. Only a tiny fraction had achieved biventricular repair five years after undergoing hybrid palliation. At the same time, the majority had either proceeded to the Fontan procedure, transplantation or, unfortunately, experienced mortality without surgical intervention. Factors significantly associated with transplantation included the absence of ductal stent, older age, lack of interatrial communication, smaller aortic root size, larger tricuspid valve area z-score, and larger left ventricular volume. Conversely, low birth weight, concomitant genetic syndrome, the use of cardiopulmonary bypass during hybrid palliation, moderate to severe tricuspid valve regurgitation, and smaller ascending aortic size were identified as factors correlated with increased mortality. Despite the high mortality rate, the study underscores the potential benefits of hybrid palliation in facilitating biventricular repair for certain infants and stabilizing others in preparation for functional univentricular palliation or primary transplantation.
Link to the article: https://www.sciencedirect.com/science/article/abs/pii/S0735109723063763
References Argo, M. B., Barron, D. J., Eghtesady, P., Yerebakan, C., DeCampli, W. M., Alsoufi, B., Honjo, O., Jacobs, J. P., Paramananthan, T., Rahman, M., Lambert, L. M., Jegatheeswaran, A., Carrillo, S. A., Husain, S. A., Ramakrishnan, K., Caldarone, C. A., Karamlou, T., Nelson, J., Mannie, C., … McCrindle, B. W. (2023). Outcomes after hybrid palliation for infants with critical left heart obstruction. Journal of the American College of Cardiology, 82(14), 1427–1441. https://doi.org/10.1016/j.jacc.2023.07.020
