Initial Experience With Hybrid Palliation for Neonates With Single-Ventricle Physiology Christopher A. Caldarone, MD, Lee Benson, MD, Helen Holtby, MD,

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Presentation transcript:

Initial Experience With Hybrid Palliation for Neonates With Single-Ventricle Physiology Christopher A. Caldarone, MD, Lee Benson, MD, Helen Holtby, MD, Jia Li, MD, PhD, Andrew N. Redington, MD, Glen S. Van Arsdell, MD The Annals of Thoracic Surgery Volume 84, Issue 4, Pages 1294-1300 (October 2007) DOI: 10.1016/j.athoracsur.2007.04.127 Copyright © 2007 The Society of Thoracic Surgeons Terms and Conditions

Fig 1 Schematic depicts patient outcomes for neonates undergoing the hybrid procedure for each of three primary indications. (CHB = complete heart block; ECMO = extracorporeal membrane oxygenation; NEC = necrotizing enterocolitis; PA = pulmonary artery; RAA = right aortic arch; POD = postoperative day; TV = tricuspid valve.) The Annals of Thoracic Surgery 2007 84, 1294-1300DOI: (10.1016/j.athoracsur.2007.04.127) Copyright © 2007 The Society of Thoracic Surgeons Terms and Conditions

Fig 2 Patient survival stratified by hybrid (solid line) or Norwood procedure (dashed line) group (p = 0.91). Each circle or hashmark represents a single patient after an uncensored or censored interval, respectively. The Annals of Thoracic Surgery 2007 84, 1294-1300DOI: (10.1016/j.athoracsur.2007.04.127) Copyright © 2007 The Society of Thoracic Surgeons Terms and Conditions

Fig 3 Patient survival stratified by indication of pretransplant (solid line), Norwood alternative (patterned line,) or salvage (dashed line; p = 0.46). Each circle or hashmark represent a single patient after an uncensored or censored interval, respectively. The Annals of Thoracic Surgery 2007 84, 1294-1300DOI: (10.1016/j.athoracsur.2007.04.127) Copyright © 2007 The Society of Thoracic Surgeons Terms and Conditions

Fig 4 Bar chart illustrates the clinical course of patients undergoing hybrid procedures for pretransplant palliation. Time zero represents hybrid palliation and each bar terminates at the time of transplantation. Patients 2 and 3 were discharged home before transplantation. The Annals of Thoracic Surgery 2007 84, 1294-1300DOI: (10.1016/j.athoracsur.2007.04.127) Copyright © 2007 The Society of Thoracic Surgeons Terms and Conditions

Fig 5 Representative computed tomography scan of a patient after the hybrid procedure immediately before stage II palliation. The bilateral pulmonary artery bands are seen in (a). The aorta and main pulmonary artery are outlined in (b). Panel c outlines the pulmonary artery confluence, which must remain posterior to the reconstructed aortic arch (composed of the ascending aorta and homograft of approximately the same diameter as the main pulmonary artery). The central confluence typically is bulky and excessive and can cause pulmonary artery compression through twisting and kinking when left intact behind the reconstructed aortic arch. Generous resection at the points marked by the curved arrow results in a slender, nonobstructive pulmonary artery confluence (d). The Annals of Thoracic Surgery 2007 84, 1294-1300DOI: (10.1016/j.athoracsur.2007.04.127) Copyright © 2007 The Society of Thoracic Surgeons Terms and Conditions