From Surgical to Total Transcatheter Stage I Palliation: Exploring Evidence and Perspectives
Neonates with single ventricle physiology and ductal-dependent systemic circulation, such as those with hypoplastic left heart syndrome, undergo palliation in the first days of life. Over the past decades, variations on the traditional Stage 1 palliation, also known as Norwood operation, have emerge...
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| Published in | Seminars in thoracic and cardiovascular surgery. Pediatric cardiac surgery annual Vol. 27; pp. 3 - 10 |
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| Main Authors | , , , |
| Format | Journal Article |
| Language | English |
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United States
Elsevier Inc
2024
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| Abstract | Neonates with single ventricle physiology and ductal-dependent systemic circulation, such as those with hypoplastic left heart syndrome, undergo palliation in the first days of life. Over the past decades, variations on the traditional Stage 1 palliation, also known as Norwood operation, have emerged. These include the hybrid palliation and the total transcatheter approach. Here, we review the current evidence and data on different Stage 1 approaches, with a focus on their advantages, challenges, and future perspectives. Overall, although controversy remains regarding the superiority or inferiority of one approach to another, outcomes after the Norwood and the hybrid palliation have improved over time. However, both procedures still represent high-risk approaches that entail exposure to sternotomy, surgery, and potential cardiopulmonary bypass. The total transcatheter Stage 1 palliation spares patients the surgical and cardiopulmonary bypass insults and has proven to be an effective strategy to bridge even high-risk infants to a later palliative surgery, complete repair, or transplant. As the most recently proposed approach, data are still limited but promising. Future studies will be needed to better define the advantages, challenges, outcomes, and overall potential of this novel approach. |
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| AbstractList | Neonates with single ventricle physiology and ductal-dependent systemic circulation, such as those with hypoplastic left heart syndrome, undergo palliation in the first days of life. Over the past decades, variations on the traditional Stage 1 palliation, also known as Norwood operation, have emerged. These include the hybrid palliation and the total transcatheter approach. Here, we review the current evidence and data on different Stage 1 approaches, with a focus on their advantages, challenges, and future perspectives. Overall, although controversy remains regarding the superiority or inferiority of one approach to another, outcomes after the Norwood and the hybrid palliation have improved over time. However, both procedures still represent high-risk approaches that entail exposure to sternotomy, surgery, and potential cardiopulmonary bypass. The total transcatheter Stage 1 palliation spares patients the surgical and cardiopulmonary bypass insults and has proven to be an effective strategy to bridge even high-risk infants to a later palliative surgery, complete repair, or transplant. As the most recently proposed approach, data are still limited but promising. Future studies will be needed to better define the advantages, challenges, outcomes, and overall potential of this novel approach. |
| Author | Eghtesady, Pirooz Maschietto, Nicola Sperotto, Francesca Zea-Vera, Rodrigo |
| Author_xml | – sequence: 1 givenname: Rodrigo surname: Zea-Vera fullname: Zea-Vera, Rodrigo organization: Division of Pediatric Cardiothoracic Surgery, Department of Surgery, Washington University, Saint Louis, Missouri – sequence: 2 givenname: Francesca surname: Sperotto fullname: Sperotto, Francesca organization: Department of Cardiology, Boston Children's Hospital, and Department of Pediatrics, Harvard Medical School, Boston, Massachusetts – sequence: 3 givenname: Pirooz surname: Eghtesady fullname: Eghtesady, Pirooz email: eghtesadyp@wustl.edu organization: Division of Pediatric Cardiothoracic Surgery, Department of Surgery, Washington University, Saint Louis, Missouri – sequence: 4 givenname: Nicola surname: Maschietto fullname: Maschietto, Nicola organization: Department of Cardiology, Boston Children's Hospital, and Department of Pediatrics, Harvard Medical School, Boston, Massachusetts |
| BackLink | https://www.ncbi.nlm.nih.gov/pubmed/38522869$$D View this record in MEDLINE/PubMed |
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| Cites_doi | 10.1016/S0022-5223(02)73575-7 10.1007/s00246-014-1015-2 10.1097/CCE.0000000000000183 10.1007/s00246-004-0962-4 10.1056/NEJMoa0912461 10.1007/s00431-023-05055-4 10.1053/j.pcsu.2005.01.009 10.1136/hrt.67.3.240 10.1016/S0022-5223(19)39288-8 10.1016/j.jtcvs.2013.09.075 10.1016/j.jtcvs.2014.02.066 10.1016/j.jacc.2011.09.022 10.1161/01.CIR.99.20.2621 10.1016/j.athoracsur.2008.02.009 10.1161/JAHA.119.015304 10.1136/heart.89.6.645 10.1161/CIRCULATIONAHA.121.055183 10.1016/j.athoracsur.2009.03.061 10.1056/NEJM198301063080106 10.1161/JAHA.120.019396 10.1016/j.jtcvs.2005.07.053 10.1007/s00246-015-1301-7 |
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| Keywords | BTT CS2 SV single ventricle MVP transcatheter Stage 1 HLHS Norwood procedure outcomes congenital heart disease Stage 1 palliation PFR hybrid procedure |
| Language | English |
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care among 5 centers publication-title: J Am Heart Assoc doi: 10.1161/JAHA.120.019396 contributor: fullname: Sperotto – volume: 131 start-page: 163 year: 2006 ident: 10.1053/j.pcsu.2023.12.002_bib0020 article-title: Single-ventricle palliation for high-risk neonates: the emergence of an alternative hybrid stage I strategy publication-title: J Thorac Cardiovasc Surg doi: 10.1016/j.jtcvs.2005.07.053 contributor: fullname: Bacha – volume: 37 start-page: 465 issue: 3 year: 2016 ident: 10.1053/j.pcsu.2023.12.002_bib0024 article-title: Extended application of the hybrid procedure in neonates with left-sided obstructive lesions in an evolving cardiac program publication-title: Pediatr Cardiol doi: 10.1007/s00246-015-1301-7 contributor: fullname: Taqatqa – volume: S0022-5223 issue: 23 year: 2023 ident: 10.1053/j.pcsu.2023.12.002_bib0007 article-title: Hybrid palliation versus nonhybrid management for a multi-institutional cohort of infants with critical left heart obstruction publication-title: J Thorac Cardiovasc Surg contributor: fullname: Argo |
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| SubjectTerms | congenital heart disease hybrid procedure Norwood procedure outcomes single ventricle Stage 1 palliation transcatheter Stage 1 |
| Title | From Surgical to Total Transcatheter Stage I Palliation: Exploring Evidence and Perspectives |
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