Improved survival of patients undergoing palliation of hypoplastic left heart syndrome: lessons learned from 115 consecutive patients. Circulation 2002 Sep 24;106(12 Suppl 1):I82-9
Date
10/02/2002Pubmed ID
12354714Scopus ID
2-s2.0-0037167689 (requires institutional sign-in at Scopus site) 506 CitationsAbstract
BACKGROUND: Outcome of stage 1 palliation (S1P) for hypoplastic left heart syndrome (HLHS) has improved coincident with application of treatment strategies including continuous superior vena cava oximetry (SvO2), phenoxybenzamine (POB), strategies to minimize the duration of deep hypothermic circulatory arrest (DHCA) and efforts to ameliorate the inflammatory response to cardiopulmonary bypass (CPB) using aprotinin and modified ultrafiltration.
METHODS AND RESULTS: Analysis of a consecutive series of 115 patients undergoing S1P was done to identify the risk factors for mortality and the impact of new treatment strategies. For the current era, July 1996 to October 2001, hospital survival was 93% (75/81) compared with 53% (18/34) for the time period, January 1992 to June 1996, P<0.001. Survival to stage 2 palliation (S2P) was also significantly improved in the current era, 81% (66/81) versus 44% (15/34), P<0.01. Anti-inflammatory treatment strategies demonstrated improved survival by univariate analysis (P<0.001). Multivariate analysis identified continuous SvO2 monitoring as a factor favoring S1P survival (P=0.02) and use of POB as a factor favoring survival to S2P (P=0.003). In the current era shorter duration of DHCA was associated with improved survival to S2P (P=0.02).
CONCLUSIONS: Improved survival following S1P can be achieved with strategies that allow for early identification of decreased systemic output and the use of afterload reduction to stabilize systemic vascular resistance and therefore the pulmonary to systemic flow ratio. Strategies to ameliorate the inflammatory response to CPB may decrease the degree and duration of postoperative support. Strategies to minimize duration of DHCA may improve intermediate survival and merit additional studies.
Author List
Tweddell JS, Hoffman GM, Mussatto KA, Fedderly RT, Berger S, Jaquiss RD, Ghanayem NS, Frisbee SJ, Litwin SBAuthors
Raymond T. Fedderly MD Associate Professor in the Pediatrics department at Medical College of WisconsinGeorge M. Hoffman MD Chief, Professor in the Anesthesiology department at Medical College of Wisconsin
Kathleen Mussatto Ph.D. Associate Professor in the School of Nursing department at Milwaukee School of Engineering
MESH terms used to index this publication - Major topics in bold
Anastomosis, SurgicalAnti-Inflammatory Agents
Aorta
Aprotinin
Female
Follow-Up Studies
Heart Arrest, Induced
Hospitalization
Humans
Hypoplastic Left Heart Syndrome
Infant, Newborn
Male
Models, Cardiovascular
Oximetry
Palliative Care
Phenoxybenzamine
Postoperative Period
Pulmonary Artery
Risk Factors
Survival Analysis
Time Factors