Department of Pediatric Cardiology, CS Mott Children's Hospital, University of Michigan Congenital Heart Center, Ann Arbor, Michigan, USA.
Catheter Cardiovasc Interv. 2024 Jul;104(1):71-81. doi: 10.1002/ccd.31110. Epub 2024 Jun 1.
Hybrid stage I palliation (HS1P) is an alternative approach for initial palliation in hypoplastic left heart syndrome (HLHS) patients. Unlike surgical stage I palliation where atrial septectomy is routinely performed, atrial septal intervention (ASI) during HS1P is variable. In this study, we described our experience with ASI in single ventricle (SV) patients who underwent HS1P and identified factors associated with need for ASI after HS1P.
Data were retrospectively collected for all HLHS patients who underwent HS1P at our center over the past 12 years. We evaluated ASIs performed during the HS1P (intra-HS1P ASI) and ASIs performed during the period from HS1P to the subsequent surgical stage, either interval Norwood stage I or comprehensive stage II (post-HS1P ASI). Patient factors and procedural data were compared to identify factors associated with undergoing post-HS1P ASI and the impact of ASI on patient outcomes was evaluated.
Of 50 SV patients included, 23 (46%) underwent intra-HS1P ASI and 26 (52%) underwent post-HS1P ASI. Need for post-HS1P ASI was lower among patients who had an intra-HS1P ASI as compared to those who did not (30% vs. 70%; p = 0.005). There were no significant differences in short or Midterm outcomes between patients who underwent intra-HS1P ASI or post-HS1P ASI and their counterparts.
ASI is common both during and after HS1P but is generally well tolerated and type of ASI does not significantly impact overall patient outcomes. Our findings suggest that the current approach of individualizing management of ASI in the HS1P population is effective and safe.
在左心发育不全综合征（HLHS）患者中，杂交一期姑息治疗（HS1P）是一种初始姑息治疗的替代方法。与常规进行房间隔切开术的一期姑息手术不同，HS1P 期间的房间隔介入（ASI）是可变的。在这项研究中，我们描述了在接受 HS1P 的单心室（SV）患者中进行 ASI 的经验，并确定了与 HS1P 后需要 ASI 相关的因素。
回顾性收集了过去 12 年来在我们中心接受 HS1P 的所有 HLHS 患者的数据。我们评估了 HS1P 期间进行的 ASI（HS1P 内 ASI）和 HS1P 至后续手术阶段（间隔期 Norwood 一期或全面二期）期间进行的 ASI。比较患者因素和程序数据，以确定与接受 HS1P 后 ASI 相关的因素，并评估 ASI 对患者结局的影响。
在 50 例 SV 患者中，23 例（46%）接受了 HS1P 内 ASI，26 例（52%）接受了 HS1P 后 ASI。与未行 HS1P 内 ASI 的患者相比，行 HS1P 内 ASI 的患者需要行 HS1P 后 ASI 的可能性较低（30%比 70%；p=0.005）。行 HS1P 内 ASI 或 HS1P 后 ASI 的患者与未行 ASI 的患者的短期或中期结局无显著差异。
HS1P 期间和之后 ASI 都很常见，但通常耐受性良好，AS 的类型对患者的整体结局没有显著影响。我们的研究结果表明，目前对 HS1P 人群中 ASI 管理个体化的方法是有效和安全的。
