TY - JOUR
T1 - Hybrid palliation versus nonhybrid management for a multi-institutional cohort of infants with critical left heart obstruction
AU - Argo, Madison B.
AU - Barron, David J.
AU - Bondarenko, Igor
AU - Eckhauser, Aaron
AU - Gruber, Peter J.
AU - Lambert, Linda M.
AU - Paramananthan, Tharini
AU - Rahman, Maha
AU - Winlaw, David S.
AU - Yerebakan, Can
AU - Alsoufi, Bahaaldin
AU - DeCampli, William M.
AU - Honjo, Osami
AU - Kirklin, James K.
AU - Prospero, Carol
AU - Ramakrishnan, Karthik
AU - St. Louis, James D.
AU - Turek, Joseph W.
AU - O'Brien, James E.
AU - Pizarro, Christian
AU - Anagnostopoulos, Petros V.
AU - Blackstone, Eugene H.
AU - Jacobs, Marshall L.
AU - Jegatheeswaran, Anusha
AU - Karamlou, Tara
AU - Stephens, Elizabeth H.
AU - Polimenakos, Anastasios C.
AU - Haw, Marcus P.
AU - McCrindle, Brian W.
N1 - Publisher Copyright:
© 2023 The American Association for Thoracic Surgery
PY - 2023/11
Y1 - 2023/11
N2 - Objective: To compare patient characteristics and overall survival for infants with critical left heart obstruction after hybrid palliation (bilateral pulmonary artery banding with or without ductal stenting) versus nonhybrid management (eg, Norwood, primary transplantation, biventricular repair, or transcatheter/surgical aortic valvotomy). Methods: From 2005 to 2019, 1045 infants in the Congenital Heart Surgeons' Society critical left heart obstruction cohort underwent interventions across 28 institutions. Using a balancing score propensity analysis, 214 infants who underwent hybrid palliation and 831 infants who underwent nonhybrid management were proportionately matched regarding variables significantly associated with mortality and variables noted to significantly differ between groups. Overall survival between the 2 groups was adjusted by applying balancing scores to nonparametric estimates. Results: Compared with the nonhybrid management group, infants who underwent hybrid palliation had lower birth weight, smaller gestational age, and higher prevalence of in-utero interventions, noncardiac comorbidities, preoperative mechanical ventilation, absent interatrial communication, and moderate or severe mitral valve stenosis (all P values < .03). Unadjusted 12-year survival after hybrid palliation and nonhybrid management, was 55% versus 69%, respectively. After matching, 12-year survival after hybrid palliation versus nonhybrid management was 58% versus 63%, respectively (P = .37). Among matched infants born weighing <2.5 kg, 2-year survival after hybrid palliation versus nonhybrid management was 37% versus 51%, respectively (P = .22). Conclusions: Infants born with critical left heart obstruction who undergo hybrid palliation have more high-risk characteristics and anatomy versus infants who undergo nonhybrid management. Nonetheless, after adjustment, there was no significant difference in 12-year survival after hybrid palliation versus nonhybrid management. Mortality remains high, and hybrid palliation confers no survival advantage, even for lower-birth-weight infants.
AB - Objective: To compare patient characteristics and overall survival for infants with critical left heart obstruction after hybrid palliation (bilateral pulmonary artery banding with or without ductal stenting) versus nonhybrid management (eg, Norwood, primary transplantation, biventricular repair, or transcatheter/surgical aortic valvotomy). Methods: From 2005 to 2019, 1045 infants in the Congenital Heart Surgeons' Society critical left heart obstruction cohort underwent interventions across 28 institutions. Using a balancing score propensity analysis, 214 infants who underwent hybrid palliation and 831 infants who underwent nonhybrid management were proportionately matched regarding variables significantly associated with mortality and variables noted to significantly differ between groups. Overall survival between the 2 groups was adjusted by applying balancing scores to nonparametric estimates. Results: Compared with the nonhybrid management group, infants who underwent hybrid palliation had lower birth weight, smaller gestational age, and higher prevalence of in-utero interventions, noncardiac comorbidities, preoperative mechanical ventilation, absent interatrial communication, and moderate or severe mitral valve stenosis (all P values < .03). Unadjusted 12-year survival after hybrid palliation and nonhybrid management, was 55% versus 69%, respectively. After matching, 12-year survival after hybrid palliation versus nonhybrid management was 58% versus 63%, respectively (P = .37). Among matched infants born weighing <2.5 kg, 2-year survival after hybrid palliation versus nonhybrid management was 37% versus 51%, respectively (P = .22). Conclusions: Infants born with critical left heart obstruction who undergo hybrid palliation have more high-risk characteristics and anatomy versus infants who undergo nonhybrid management. Nonetheless, after adjustment, there was no significant difference in 12-year survival after hybrid palliation versus nonhybrid management. Mortality remains high, and hybrid palliation confers no survival advantage, even for lower-birth-weight infants.
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U2 - 10.1016/j.jtcvs.2023.04.022
DO - 10.1016/j.jtcvs.2023.04.022
M3 - Article
C2 - 37164059
AN - SCOPUS:85160073264
SN - 0022-5223
VL - 166
SP - 1300-1313.e2
JO - Journal of Thoracic and Cardiovascular Surgery
JF - Journal of Thoracic and Cardiovascular Surgery
IS - 5
ER -