Fogarty William M, Phelps Christina, Galantowicz Mark, Alvarado Chance, Alexander Robin, Salavitabar Arash, Blais Benjamin, Texter Karen, Armstrong Aimee K
The Heart Center, Nationwide Children's Hospital, Columbus, Ohio.
Department of Pediatrics, The Ohio State University College of Medicine, Columbus, Ohio.
J Soc Cardiovasc Angiogr Interv. 2025 Jul 23;4(8):103731. doi: 10.1016/j.jscai.2025.103731. eCollection 2025 Aug.
The optimal timing of a balloon atrial septostomy (BAS) in patients with hypoplastic left heart syndrome (HLHS) undergoing hybrid stage 1 (HS1) palliation is unknown. We hypothesized that concomitant completion of the BAS and HS1 would decrease hospital stay, increase intensive care unit-free days, improve hemodynamic markers, and increase transplant-free survival.
We retrospectively reviewed HLHS patients palliated with HS1 from January 2009 to July 2022 at our center. We excluded other single ventricle variants, those who did not have a BAS or had a BAS performed prior to the HS1, and those with an initial atrial septal intervention other than BAS. Patients were divided into 2 groups: (1) those with same-day BAS and HS1, and (2) BAS performed ≥1 day after the HS1.
Twenty patients had a BAS and HS1 on the same day, and 69 patients had delayed BAS, whereas 29 patients were excluded. The same-day cohort had significantly shorter hospital length of stay, higher recorded cerebral near infrared spectroscopy troughs, and lower 30-day post-BAS/discharge brain natriuretic peptide levels. There was no difference in transplant-free survival, and a greater proportion of the same-day group required atrial septal reintervention.
Although there was no difference in transplant-free survival and higher rates of atrial septal reintervention, concomitant completion of BAS and HS1 in HLHS patients demonstrated shorter HS1 hospitalization and improved hemodynamic markers.
在接受一期杂交姑息治疗（HS1）的左心发育不全综合征（HLHS）患者中，球囊房间隔造口术（BAS）的最佳时机尚不清楚。我们假设，同时完成BAS和HS1将减少住院时间，增加无重症监护病房天数，改善血流动力学指标，并提高无移植生存率。
我们回顾性分析了2009年1月至2022年7月在本中心接受HS1姑息治疗的HLHS患者。我们排除了其他单心室变异患者、未进行BAS或在HS1之前进行过BAS的患者，以及除BAS之外最初进行房间隔干预的患者。患者分为两组：（1）同一天进行BAS和HS1的患者，（2）在HS1后≥1天进行BAS的患者。
20例患者在同一天进行了BAS和HS1，69例患者延迟进行BAS，29例患者被排除。同一天组的住院时间明显更短，记录的脑近红外光谱波谷更高，BAS后30天/出院时的脑钠肽水平更低。无移植生存率无差异，同一天组中需要进行房间隔再次干预的比例更高。
虽然无移植生存率无差异且房间隔再次干预率更高，但在HLHS患者中同时完成BAS和HS1显示HS1住院时间更短且血流动力学指标得到改善。
