Hybrid Versus Percutaneous Left Atrial Decompression in Infants With Hypoplastic Left Heart Variants and an Intact or Highly Restrictive Atrial Septum: A Multicenter PICES Study.

IF 6.1 1区 医学 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS
Konstantin Averin, Michael D Seckeler, Holly Bauser-Heaton, Matthew C Schwartz, Paul Tannous, Cameron Seaman, Wendy Whiteside, George T Nicholson, Priti M Patel, Brent M Gordon, Ryan A Romans, Rajiv Devanagondi, Carrie E Herbert, Sarosh P Batlivala, Brian Boe, Gurumurthy Hiremath, Jeffrey D Zampi
{"title":"Hybrid Versus Percutaneous Left Atrial Decompression in Infants With Hypoplastic Left Heart Variants and an Intact or Highly Restrictive Atrial Septum: A Multicenter PICES Study.","authors":"Konstantin Averin, Michael D Seckeler, Holly Bauser-Heaton, Matthew C Schwartz, Paul Tannous, Cameron Seaman, Wendy Whiteside, George T Nicholson, Priti M Patel, Brent M Gordon, Ryan A Romans, Rajiv Devanagondi, Carrie E Herbert, Sarosh P Batlivala, Brian Boe, Gurumurthy Hiremath, Jeffrey D Zampi","doi":"10.1161/CIRCINTERVENTIONS.124.014243","DOIUrl":null,"url":null,"abstract":"<p><strong>Background: </strong>Neonates with hypoplastic left heart syndrome variants with an intact or highly restrictive atrial septum (HLH-IAS) require immediate postnatal intervention to survive. Emergent left atrial decompression (LAD) via a percutaneous or hybrid approach is standard, but the comparative effectiveness and outcomes of these approaches remain underexplored.</p><p><strong>Methods: </strong>A multicenter retrospective analysis of all neonates with HLH-IAS who underwent LAD in the first 36 hours of life from January 2009 to March 2020 at 14 North American congenital cardiac programs was conducted. Patient and procedural characteristics and patient outcomes were compared between hybrid and percutaneous LAD.</p><p><strong>Results: </strong>Among 128 patients with HLH-IAS, 105 (80%) underwent percutaneous LAD and 23 (17%) hybrid LAD. No significant differences were observed in preprocedural characteristics such as birth weight (3.1±0.6 versus 3.2±0.6 kg; <i>P</i>=0.453), presence of a baseline interatrial communication (66% versus 61%; <i>P</i>=0.659), interatrial communication gradient (14.4±6.9 versus 12.7±4.6 mm Hg; <i>P</i>=0.456), or lowest pH (7.13±0.14 versus 7.09±0.15; <i>P</i>=0.193). Hybrid LAD resulted in a shorter time from birth to procedure (120 versus 52 minutes; <i>P</i>=0.005) and to atrial septal defect creation (55 versus 29 minutes; <i>P</i>=0.002). All hybrid LAD were technically successful, although 11 (10%) percutaneous LAD were unsuccessful with 7 requiring conversion to surgical septectomy. There was a trend toward fewer serious adverse events with hybrid LAD (36% versus 17%; <i>P</i>=0.141). Most patients (67%) who underwent hybrid LAD had simultaneous pulmonary artery band placement and 21% of patients with percutaneous LAD required reoperation for pulmonary artery band. Long-term survival rates were comparably low between groups, with a 30% transplant-free survival at a median 8-month follow-up.</p><p><strong>Conclusions: </strong>In patients with HLH-IAS, hybrid LAD allows for faster atrial septal defect creation, has a higher technical success rate, and potentially fewer procedural serious adverse events compared with percutaneous LAD, alongside facilitating simultaneous pulmonary artery band. Our findings underscore the poor prognosis for patients with HLH-IAS despite intervention, highlighting the need for better treatment strategies.</p>","PeriodicalId":10330,"journal":{"name":"Circulation: Cardiovascular Interventions","volume":"18 3","pages":"e014243"},"PeriodicalIF":6.1000,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"Circulation: Cardiovascular Interventions","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1161/CIRCINTERVENTIONS.124.014243","RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"2025/3/18 0:00:00","PubModel":"Epub","JCR":"Q1","JCRName":"CARDIAC & CARDIOVASCULAR SYSTEMS","Score":null,"Total":0}
引用次数: 0

Abstract

Background: Neonates with hypoplastic left heart syndrome variants with an intact or highly restrictive atrial septum (HLH-IAS) require immediate postnatal intervention to survive. Emergent left atrial decompression (LAD) via a percutaneous or hybrid approach is standard, but the comparative effectiveness and outcomes of these approaches remain underexplored.

Methods: A multicenter retrospective analysis of all neonates with HLH-IAS who underwent LAD in the first 36 hours of life from January 2009 to March 2020 at 14 North American congenital cardiac programs was conducted. Patient and procedural characteristics and patient outcomes were compared between hybrid and percutaneous LAD.

Results: Among 128 patients with HLH-IAS, 105 (80%) underwent percutaneous LAD and 23 (17%) hybrid LAD. No significant differences were observed in preprocedural characteristics such as birth weight (3.1±0.6 versus 3.2±0.6 kg; P=0.453), presence of a baseline interatrial communication (66% versus 61%; P=0.659), interatrial communication gradient (14.4±6.9 versus 12.7±4.6 mm Hg; P=0.456), or lowest pH (7.13±0.14 versus 7.09±0.15; P=0.193). Hybrid LAD resulted in a shorter time from birth to procedure (120 versus 52 minutes; P=0.005) and to atrial septal defect creation (55 versus 29 minutes; P=0.002). All hybrid LAD were technically successful, although 11 (10%) percutaneous LAD were unsuccessful with 7 requiring conversion to surgical septectomy. There was a trend toward fewer serious adverse events with hybrid LAD (36% versus 17%; P=0.141). Most patients (67%) who underwent hybrid LAD had simultaneous pulmonary artery band placement and 21% of patients with percutaneous LAD required reoperation for pulmonary artery band. Long-term survival rates were comparably low between groups, with a 30% transplant-free survival at a median 8-month follow-up.

Conclusions: In patients with HLH-IAS, hybrid LAD allows for faster atrial septal defect creation, has a higher technical success rate, and potentially fewer procedural serious adverse events compared with percutaneous LAD, alongside facilitating simultaneous pulmonary artery band. Our findings underscore the poor prognosis for patients with HLH-IAS despite intervention, highlighting the need for better treatment strategies.

混合与经皮左心减压对左心发育不全和房间隔完整或高度受限婴儿的影响:一项多中心PICES研究
背景:具有完整或高度限制性房间隔(HLH-IAS)的左心发育不全综合征变异新生儿需要立即进行产后干预才能存活。紧急左心房减压(LAD)经皮或混合入路是标准的,但这些入路的相对有效性和结果仍未得到充分探讨。方法:对2009年1月至2020年3月14个北美先天性心脏项目中所有在出生后36小时内接受LAD治疗的HLH-IAS新生儿进行多中心回顾性分析。比较混合型和经皮LAD的患者和手术特点及患者预后。结果:128例HLH-IAS患者中,105例(80%)行经皮LAD, 23例(17%)行混合型LAD。两组的术前特征无显著差异,如出生体重(3.1±0.6 vs 3.2±0.6 kg);P=0.453),存在基线房间通讯(66%对61%;P=0.659),房间交通梯度(14.4±6.9 vs 12.7±4.6 mm Hg;P=0.456)或最低pH值(7.13±0.14 vs 7.09±0.15;P = 0.193)。混合型LAD从出生到手术的时间更短(120分钟比52分钟;P=0.005)和房间隔缺损形成(55分钟vs 29分钟;P = 0.002)。所有混合型LAD在技术上都是成功的,尽管11例(10%)经皮LAD不成功,7例需要转换为手术隔膜切除术。混合型LAD的严重不良事件较少(36% vs 17%;P = 0.141)。大多数(67%)混合型LAD患者同时放置肺动脉带,21%经皮LAD患者需要肺动脉带再手术。两组之间的长期生存率相对较低,中位随访8个月时无移植生存率为30%。结论:在HLH-IAS患者中,与经皮LAD相比,混合LAD可以更快地形成房间隔缺损,具有更高的技术成功率,并且可能更少的程序性严重不良事件,并且可以同时促进肺动脉束。我们的研究结果强调了尽管有干预,但HLH-IAS患者预后较差,强调了更好的治疗策略的必要性。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
求助全文
约1分钟内获得全文 求助全文
来源期刊
Circulation: Cardiovascular Interventions
Circulation: Cardiovascular Interventions CARDIAC & CARDIOVASCULAR SYSTEMS-
CiteScore
10.30
自引率
1.80%
发文量
221
审稿时长
6-12 weeks
期刊介绍: Circulation: Cardiovascular Interventions, an American Heart Association journal, focuses on interventional techniques pertaining to coronary artery disease, structural heart disease, and vascular disease, with priority placed on original research and on randomized trials and large registry studies. In addition, pharmacological, diagnostic, and pathophysiological aspects of interventional cardiology are given special attention in this online-only journal.
×
引用
GB/T 7714-2015
复制
MLA
复制
APA
复制
导出至
BibTeX EndNote RefMan NoteFirst NoteExpress
×
提示
您的信息不完整,为了账户安全,请先补充。
现在去补充
×
提示
您因"违规操作"
具体请查看互助需知
我知道了
×
提示
确定
请完成安全验证×
copy
已复制链接
快去分享给好友吧!
我知道了
右上角分享
点击右上角分享
0
联系我们:info@booksci.cn Book学术提供免费学术资源搜索服务,方便国内外学者检索中英文文献。致力于提供最便捷和优质的服务体验。 Copyright © 2023 布克学术 All rights reserved.
京ICP备2023020795号-1
ghs 京公网安备 11010802042870号
Book学术文献互助
Book学术文献互助群
群 号:481959085
Book学术官方微信