背景:混合I期缓解(HS1P)是左心发育不良综合征(HLHS)患者初始缓解的替代方法。与常规进行房间隔切除术的手术I期姑息治疗不同,HS1P期间的房间隔介入(ASI)是可变的。在这项研究中,我们描述了接受HS1P的单心室(SV)患者接受ASI的经验,并确定了HS1P后需要ASI的相关因素.
方法:回顾性收集了过去12年在我们中心接受HS1P治疗的所有HLHS患者的数据。我们评估了在HS1P(HS1P内ASI)和从HS1P到随后手术阶段期间进行的ASIs,间隔诺伍德I期或综合II期(HS1PASI后)。比较患者因素和手术数据,以确定与接受HS1P后ASI相关的因素,并评估ASI对患者预后的影响。
结果:包括50例SV患者,23例(46%)接受HS1PASI内治疗,26例(52%)接受HS1PASI后治疗。与没有HS1PASI的患者相比,患有HS1PASI后的患者对HS1PASI的需求较低(30%与70%;p=0.005)。在接受HS1PASI内或HS1PASI后的患者及其对应者之间,短期或中期结局没有显着差异。
结论:ASI在HS1P期间和之后都很常见,但通常具有良好的耐受性,ASI的类型对患者的总体预后没有显著影响。我们的发现表明,目前在HS1P人群中对ASI进行个性化管理的方法是有效且安全的。
BACKGROUND: Hybrid stage I palliation (HS1P) is an alternative approach for initial palliation in hypoplastic left heart syndrome (HLHS) patients. Unlike surgical stage I palliation where atrial septectomy is routinely performed, atrial septal intervention (ASI) during HS1P is variable. In this study, we described our experience with ASI in single ventricle (SV) patients who underwent HS1P and identified factors associated with need for ASI after HS1P.
METHODS: Data were retrospectively collected for all HLHS patients who underwent HS1P at our center over the past 12 years. We evaluated ASIs performed during the HS1P (intra-HS1P ASI) and ASIs performed during the period from HS1P to the subsequent surgical stage, either interval Norwood stage I or comprehensive stage II (post-HS1P ASI). Patient factors and procedural data were compared to identify factors associated with undergoing post-HS1P ASI and the impact of ASI on patient outcomes was evaluated.
RESULTS: Of 50 SV patients included, 23 (46%) underwent intra-HS1P ASI and 26 (52%) underwent post-HS1P ASI. Need for post-HS1P ASI was lower among patients who had an intra-HS1P ASI as compared to those who did not (30% vs. 70%; p = 0.005). There were no significant differences in short or Midterm outcomes between patients who underwent intra-HS1P ASI or post-HS1P ASI and their counterparts.
CONCLUSIONS: ASI is common both during and after HS1P but is generally well tolerated and type of ASI does not significantly impact overall patient outcomes. Our findings suggest that the current approach of individualizing management of ASI in the HS1P population is effective and safe.