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Open AccessSystematic Review
Comparison of Morbidity and Mortality Outcomes between Hybrid Palliation and Norwood Palliation Procedures for Hypoplastic Left Heart Syndrome: Meta-Analysis and Systematic Review
by
Christopher Iskander
Christopher Iskander 1,
Ugonna Nwankwo
Ugonna Nwankwo 1,
Krithika K. Kumanan
Krithika K. Kumanan 2,
Saurabh Chiwane
Saurabh Chiwane 3,
Vernat Exil
Vernat Exil 1,
Lia Lowrie
Lia Lowrie 4,
Corinne Tan
Corinne Tan 5,
Charles Huddleston
Charles Huddleston 5 and
Hemant S. Agarwal
Hemant S. Agarwal 4,*
1
Division of Pediatric Cardiology, Cardinal Glennon Children’s Hospital, Saint Louis, MO 63104, USA
2
Advanced Data Health Institution, Saint Louis University, Saint Louis, MO 63104, USA
3
Division of Pediatric Critical Care Medicine, Loma Linda University, Loma Linda, CA 92354, USA
4
Division of Pediatric Critical Care Medicine, Cardinal Glennon Children’s Hospital, Saint Louis, MO 63104, USA
5
Department of Pediatric Cardio-Thoracic Surgery, Cardinal Glennon Children’s Hospital, Saint Louis, MO 63104, USA
*
Author to whom correspondence should be addressed.
J. Clin. Med. 2024, 13(14), 4244; https://doi.org/10.3390/jcm13144244 (registering DOI)
Submission received: 30 April 2024
/
Revised: 20 June 2024
/
Accepted: 5 July 2024
/
Published: 20 July 2024
Abstract
Background/Objectives: Hybrid palliation (HP) procedures for hypoplastic left heart syndrome (HLHS) are increasing. Our objective was to compare mortality and morbidity following HP and NP (Norwood palliation) procedures. Methods: Systematic review and meta-analysis of HLHS patients of peer-reviewed literature between 2000 and 2023. Mortality and/or heart transplantation in HP versus NP in the neonatal period, interstage period, and at 1, 3 and 5 years of age, and morbidity including completion of Stage II and Stage III palliation, unexpected interventions, pulmonary artery pressures, right ventricle function, neurodevelopmental outcomes and length of hospital stay were evaluated. Results: Twenty-one (meta-analysis: 16; qualitative synthesis: 5) studies evaluating 1182 HLHS patients included. HP patients had higher interstage mortality (RR = 1.61; 95% CI: 1.10–2.33; p = 0.01) and 1-year mortality (RR = 1.22; 95% CI: 1.03–1.43; p = 0.02) compared to NP patients without differences in 3- and 5-years mortality. HP procedure in high-risk HLHS patients had lower mortality (RR = 0.48; 95% CI: 0.27–0.87; p = 0.01) only in the neonatal period. HP patients underwent fewer Stage II (RR = 0.90; 95% CI: 0.81–1.00; p = 0.05) and Stage III palliation (RR = 0.78; 95% CI: 0.69–0.90; p < 0.01), had more unplanned interventions (RR = 3.38; 95% CI: 2.04–5.59; p < 0.01), and longer hospital stay after Stage I palliation (weighted mean difference = 12.88; 95% CI: 1.15–24.62; p = 0.03) compared to NP patients. Conclusions: Our study reveals that HP, compared to NP for HLHS, is associated with increased morbidity risk without an improved survival rate.
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MDPI and ACS Style
Iskander, C.; Nwankwo, U.; Kumanan, K.K.; Chiwane, S.; Exil, V.; Lowrie, L.; Tan, C.; Huddleston, C.; Agarwal, H.S.
Comparison of Morbidity and Mortality Outcomes between Hybrid Palliation and Norwood Palliation Procedures for Hypoplastic Left Heart Syndrome: Meta-Analysis and Systematic Review. J. Clin. Med. 2024, 13, 4244.
https://doi.org/10.3390/jcm13144244
AMA Style
Iskander C, Nwankwo U, Kumanan KK, Chiwane S, Exil V, Lowrie L, Tan C, Huddleston C, Agarwal HS.
Comparison of Morbidity and Mortality Outcomes between Hybrid Palliation and Norwood Palliation Procedures for Hypoplastic Left Heart Syndrome: Meta-Analysis and Systematic Review. Journal of Clinical Medicine. 2024; 13(14):4244.
https://doi.org/10.3390/jcm13144244
Chicago/Turabian Style
Iskander, Christopher, Ugonna Nwankwo, Krithika K. Kumanan, Saurabh Chiwane, Vernat Exil, Lia Lowrie, Corinne Tan, Charles Huddleston, and Hemant S. Agarwal.
2024. "Comparison of Morbidity and Mortality Outcomes between Hybrid Palliation and Norwood Palliation Procedures for Hypoplastic Left Heart Syndrome: Meta-Analysis and Systematic Review" Journal of Clinical Medicine 13, no. 14: 4244.
https://doi.org/10.3390/jcm13144244
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