Morray Brian H, Albers Erin L, Jones Thomas K, Kemna Mariska S, Permut Lester C, Law Yuk M
Division of Pediatric Cardiology, Seattle Children's Hospital, University of Washington, Seattle, Washington.
Division of Pediatric Cardiothoracic Surgery, Seattle Children's Hospital, University of Washington, Seattle, Washington.
Pediatr Transplant. 2018 Dec;22(8):e13307. doi: 10.1111/petr.13307. Epub 2018 Oct 19.
The hybrid stage 1 palliation for hypoplastic left heart syndrome (HLHS) was first described in 1993 as a bridge to heart transplant for HLHS. There are limited data on this strategy as primary heart transplantation for HLHS has become less common.
This is an observational, single-center study comparing pre- and post-transplant outcomes of patients listed for transplant following hybrid palliation with those following surgical stage 1 palliation.
From 2004 to 2017, 21 patients underwent hybrid palliation as a bridge to heart transplant and 28 patients were listed for transplant following surgical stage 1 palliation or aortic arch repair and pulmonary artery band placement. Premature birth and the presence of genetic or anatomic abnormalities were more common in the hybrid group. Need for extracorporeal membrane oxygenation (ECMO) support and ventricular dysfunction was more common in the surgical group. There was a trend toward shorter waitlist times in the surgical cohort (36 days vs 70 days, P = 0.06). There was no difference in waitlist mortality (19% vs 21%, P = 0.61). Survival at 1 and 5 years post-transplant was similar for the hybrid and surgical cohorts (5-year survival, 80% vs 85%, P = 0.94, respectively). There was no difference in the number of post-transplant interventions.
Although the hybrid patients represented a higher risk cohort and demonstrated longer wait times, the waitlist and post-transplant mortality was equivalent between the two groups. For high-risk patients, the hybrid palliation as a bridge to transplant appears to be a reasonable strategy.
1993年首次描述了用于左心发育不全综合征（HLHS）的一期混合姑息治疗，作为HLHS心脏移植的桥梁。由于HLHS的原发性心脏移植已不那么常见，关于这一策略的数据有限。
这是一项单中心观察性研究，比较接受混合姑息治疗后等待移植的患者与接受一期手术姑息治疗后等待移植的患者的移植前后结局。
2004年至2017年，21例患者接受混合姑息治疗作为心脏移植的桥梁，28例患者在接受一期手术姑息治疗或主动脉弓修复及肺动脉环扎术后等待移植。早产以及遗传或解剖异常在混合组中更常见。手术组需要体外膜肺氧合（ECMO）支持和心室功能障碍的情况更常见。手术队列的等待时间有缩短趋势（36天对70天，P = 0.06）。等待名单上的死亡率无差异（19%对21%，P = 0.61）。混合组和手术组移植后1年和5年的生存率相似（5年生存率分别为80%对85%，P = 0.94）。移植后干预次数无差异。
尽管混合组患者代表了更高风险的队列且等待时间更长，但两组在等待名单和移植后的死亡率相当。对于高危患者，混合姑息治疗作为移植的桥梁似乎是一种合理的策略。
