Single-ventricle palliation for high-risk neonates: The emergence of an alternative hybrid stage I strategy
Single-ventricle palliation for high-risk neonates: The emergence of an alternative hybrid stage I strategy
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DOI：
10.1016/j.jtcvs.2005.07.053
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发表时间：
2006-01-01
影响因子：
6
通讯作者：
Hijazi, ZM
中科院分区：
文献类型：
--
作者：
Bacha, EA;Daves, S;Hijazi, ZM
背景：高危新生儿在针对左心发育不全综合征或相关异常进行 I 期姑息治疗后，生存率仍然很低。我们假设侵入性较小的混合方法对该患者群体有益。方法：混合 I 期手术在导管实验室中进行。通过胸骨正中切开术，将两个分支肺动脉绑扎起来，并通过主肺动脉穿刺输送导管支架，并在荧光镜引导下定位。结果：2003年10月至2005年6月。14名高危新生儿接受了混合I期手术。 14 人中有 11 人患有左心发育不全综合征。 2 例还接受了心房间隔支架置入术，5 例随后需要经皮心房支架置入术。两名房间隔完整或高度受限的新生儿接受了紧急经皮心房支架置入术。 14 名患者中有 11 名住院存活（78.5%）。一名患者需要体外膜肺氧合支持术中心脏骤停。他接受了心脏移植，但后来死于败血症。一名患者死于导管支架栓塞，三分之一患者死于进行性心功能不全。前 4 名患者需要进行肺动脉带修复。在我们修改技术并添加分支肺动脉血管造影后，没有发现任何异常。因心房支架闭塞和导管前逆行缩窄导致 2 例间期死亡。八名患者接受了 II 期手术，包括主动脉弓重建、房间隔切除术和腔静脉肺分流术。两名患者在第二阶段后死亡。一名患者正在等待 II 期。结论：I 期混合姑息治疗对于高危新生儿来说是一种有效的选择。随着经验的积累，它可能会成为首选选择。然而，在主动脉闭锁中，导管前逆行缩窄的发展是一个重大问题。
Background: Survival after stage I palliation for hypoplastic left heart syndrome or related anomalies remains poor in high-risk neonates. We hypothesized that a less invasive hybrid approach would be beneficial in this patient population.Methods: The hybrid stage I procedure was performed in the catheterization laboratory. Via a median sternotomy, both branch pulmonary arteries were banded, and a ductal stent was delivered via a main pulmonary artery puncture and positioned under fluoroscopic guidance.Results: Between October 2003 and June 2005. 14 high-risk neonates underwent a hybrid stage I procedure. Eleven of 14 had hypoplastic left heart syndrome. Two also underwent peratrial atrial septal stenting and 5 required percutaneous atrial stenting later. Two neonates with an intact or highly restrictive atrial septum had emergency percutaneous atrial stent placement. Hospital survival was 11 (78.5%) of 14. One patient required extracorporeal membrane oxygenation Support for intraoperative cardiac arrest. He underwent cardiac transplantation but died later of sepsis. One patient died of ductal stent embolization, and a third died of progressive cardiac dysfunction. The first 4 patients required pulmonary artery band revisions. There were none after we modified our technique and added branch pulmonary artery angiograms. There were 2 interstage deaths from atrial stent occlusion and from preductal retrograde coarctation. Eight patients underwent stage II procedures, consisting of aortic arch reconstruction, atrial septectomy, and cavopulmonary shunt. Two patients died after stage II. One patient is awaiting stage II.Conclusions: The hybrid stage I palliation is a valid option in high-risk neonates. As experience is accrued, it may becorne the preferred alternative. However, in aortic atresia, the development of preductal retrograde coarctation is a significant problem.