Timing of Balloon Atrial Septostomy in Hybrid Stage 1 Palliation in Hypoplastic Left Heart Syndrome

Abstract

Background

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.

Methods

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.

Results

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.

Conclusions

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.