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Hybrid palliation versus nonhybrid management for a multi-institutional cohort of infants with critical left heart obstruction.

Publication ,  Journal Article
Argo, MB; Barron, DJ; Bondarenko, I; Eckhauser, A; Gruber, PJ; Lambert, LM; Paramananthan, T; Rahman, M; Winlaw, DS; Yerebakan, C; Alsoufi, B ...
Published in: J Thorac Cardiovasc Surg
November 2023

OBJECTIVE: To compare patient characteristics and overall survival for infants with critical left heart obstruction after hybrid palliation (bilateral pulmonary artery banding with or without ductal stenting) versus nonhybrid management (eg, Norwood, primary transplantation, biventricular repair, or transcatheter/surgical aortic valvotomy). METHODS: From 2005 to 2019, 1045 infants in the Congenital Heart Surgeons' Society critical left heart obstruction cohort underwent interventions across 28 institutions. Using a balancing score propensity analysis, 214 infants who underwent hybrid palliation and 831 infants who underwent nonhybrid management were proportionately matched regarding variables significantly associated with mortality and variables noted to significantly differ between groups. Overall survival between the 2 groups was adjusted by applying balancing scores to nonparametric estimates. RESULTS: Compared with the nonhybrid management group, infants who underwent hybrid palliation had lower birth weight, smaller gestational age, and higher prevalence of in-utero interventions, noncardiac comorbidities, preoperative mechanical ventilation, absent interatrial communication, and moderate or severe mitral valve stenosis (all P values < .03). Unadjusted 12-year survival after hybrid palliation and nonhybrid management, was 55% versus 69%, respectively. After matching, 12-year survival after hybrid palliation versus nonhybrid management was 58% versus 63%, respectively (P = .37). Among matched infants born weighing <2.5 kg, 2-year survival after hybrid palliation versus nonhybrid management was 37% versus 51%, respectively (P = .22). CONCLUSIONS: Infants born with critical left heart obstruction who undergo hybrid palliation have more high-risk characteristics and anatomy versus infants who undergo nonhybrid management. Nonetheless, after adjustment, there was no significant difference in 12-year survival after hybrid palliation versus nonhybrid management. Mortality remains high, and hybrid palliation confers no survival advantage, even for lower-birth-weight infants.

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Published In

J Thorac Cardiovasc Surg

DOI

EISSN

1097-685X

Publication Date

November 2023

Volume

166

Issue

5

Start / End Page

1300 / 1313.e2

Location

United States

Related Subject Headings

  • Respiratory System
  • 3202 Clinical sciences
  • 3201 Cardiovascular medicine and haematology
  • 1103 Clinical Sciences
  • 1102 Cardiorespiratory Medicine and Haematology
 

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Argo, M. B., Barron, D. J., Bondarenko, I., Eckhauser, A., Gruber, P. J., Lambert, L. M., … McCrindle, B. W. (2023). Hybrid palliation versus nonhybrid management for a multi-institutional cohort of infants with critical left heart obstruction. J Thorac Cardiovasc Surg, 166(5), 1300-1313.e2. https://doi.org/10.1016/j.jtcvs.2023.04.022
Argo, Madison B., David J. Barron, Igor Bondarenko, Aaron Eckhauser, Peter J. Gruber, Linda M. Lambert, Tharini Paramananthan, et al. “Hybrid palliation versus nonhybrid management for a multi-institutional cohort of infants with critical left heart obstruction.J Thorac Cardiovasc Surg 166, no. 5 (November 2023): 1300-1313.e2. https://doi.org/10.1016/j.jtcvs.2023.04.022.
Argo MB, Barron DJ, Bondarenko I, Eckhauser A, Gruber PJ, Lambert LM, et al. Hybrid palliation versus nonhybrid management for a multi-institutional cohort of infants with critical left heart obstruction. J Thorac Cardiovasc Surg. 2023 Nov;166(5):1300-1313.e2.
Argo, Madison B., et al. “Hybrid palliation versus nonhybrid management for a multi-institutional cohort of infants with critical left heart obstruction.J Thorac Cardiovasc Surg, vol. 166, no. 5, Nov. 2023, pp. 1300-1313.e2. Pubmed, doi:10.1016/j.jtcvs.2023.04.022.
Argo MB, Barron DJ, Bondarenko I, Eckhauser A, Gruber PJ, Lambert LM, Paramananthan T, Rahman M, Winlaw DS, Yerebakan C, Alsoufi B, DeCampli WM, Honjo O, Kirklin JK, Prospero C, Ramakrishnan K, St Louis JD, Turek JW, O’Brien JE, Pizarro C, Anagnostopoulos PV, Blackstone EH, Jacobs ML, Jegatheeswaran A, Karamlou T, Stephens EH, Polimenakos AC, Haw MP, McCrindle BW. Hybrid palliation versus nonhybrid management for a multi-institutional cohort of infants with critical left heart obstruction. J Thorac Cardiovasc Surg. 2023 Nov;166(5):1300-1313.e2.
Journal cover image

Published In

J Thorac Cardiovasc Surg

DOI

EISSN

1097-685X

Publication Date

November 2023

Volume

166

Issue

5

Start / End Page

1300 / 1313.e2

Location

United States

Related Subject Headings

  • Respiratory System
  • 3202 Clinical sciences
  • 3201 Cardiovascular medicine and haematology
  • 1103 Clinical Sciences
  • 1102 Cardiorespiratory Medicine and Haematology