Division of Cardiovascular Surgery, The Labatt Family Heart Centre, The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada.
Circulation. 2012 Sep 11;126(11 Suppl 1):S123-31. doi: 10.1161/CIRCULATIONAHA.111.084616.
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.
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).
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.
在第二期姑息性手术方面，杂交和 Norwood 策略在很大程度上存在差异。我们旨在比较这些策略，重点是第二期后及随后的 Fontan 完成后的生存率和再干预。
在 2004 年至 2010 年间接受一期姑息性治疗的 110 例功能性单心室生理患儿中，75 例（69%）婴儿（Norwood 组，n=43；杂交组，n=32）随后接受二期姑息性治疗。比较两组二期姑息性治疗后的生存率和再干预率、Fontan 评估前的解剖和生理变量以及 Fontan 结局。分析再干预的预测因素。二期姑息性治疗后，两组无死亡/移植生存率相当（Norwood 组为 80.4%，杂交组为 85.6%，3 年时，P=0.66）。杂交组肺动脉（PA）再干预率较高（P=0.003），Fontan 评估前 Nakata 指数较低（P=0.015）。主动脉弓和房室瓣再干预两组间无差异。Fontan 评估前心室舒张末期压、平均 PA 压和心室功能无差异。Fontan 完成后两组均无死亡（Norwood 组，n=25；杂交组，n=14）。
二期姑息性治疗和随后的 Fontan 完成后生存率在两组间相当。杂交组 PA 再干预率较高，PA 较小。两种策略均为 Fontan 完成提供了足够的生理学条件。杂交策略的发展需要改进，以提供最佳的 PA 生长。
