Hybrid palliation to promote growth of left ventricle and left ventricular outflow tract.
Eising JB, Bökenkamp R, Schneider AW, Kuipers IM, Hazekamp MG. Eur J Cardiothorac Surg. 2024 Jul 1;66(1):ezae275. doi: 10.1093/ejcts/ezae275.PMID: 39037957
Take Home Points:
- In patients who have small LV structure with relatively good size of MV (z score -1.7), BVR can be achieved after hybrid procedure with increase in aortic valve and LV size.
- Close follow-up is important in patients having hybrid procedure as longer waiting period can be a risk.
Commentary from Dr. Yasuhiro Kotani (Okayama, Japan), chief section editor of Congenital Heart Surgery Journal Watch
Summary:
This is a single center retrospective study, looking at impact of hybrid procedure on LV growth. The study included 66 patients and hybrid palliation was used in 38 patients to promote growth of left ventricular structures. In total, 15 patients received a Ross- Konno/Yasui procedure, while 23 patients received conventional BVR. In patients with a conventional BVR, a significant increase was found in left ventricular volume indexed by body surface area, Z-score of aortic valve and left ventricular outflow tract (LVOT) between hybrid palliation and BVR. Mitral valve Z-score did not increase significantly. After BVR until follow-up, only increase of the aortic valve Z-scores and left ventricular volume indexed by body surface area was found significant. Of all included patients (n=38), additional surgical procedures were necessary in 8 patients during the interstage period and 15 patients after BVR. Additional catheter interventions were needed in 14 patients in the interstage period and 15 after BVR. Six patients died, with no mortality in the conventional BVR group.
Comment:
The authors suggest that close follow-up is very important to aim BVR. Their intention is to keep the bilateral PAB not too long (median age at BVR was 78days) and previous report also showed that a longer period with bilateral PA-bands (>90days) increased the risk of reinterventions. The authors also emphasis that atrial communication should be restrictive (4mm in size) in the setting of bilateral PAB. Another important finding from this study is MV size did not increase in this surgical strategy. However, this is not surprising because patients who achieved BVR after hybrid had a relatively large size of MV z-score (-1.7). It may be technically feasible to intervene aortic valve and LVOT at the time of BVR, but intervention on the MV would be difficult in this patient group.
