DIFFUSION OF INNOVATIVE APPROACHES TO MANAGING HYPOPLASTIC LEFT-HEARTSYNDROME

Objective: To study the perceptions of outcome and the diffusion into practice of innovative approaches such as palliative surgery and heart transplantation to treat hypoplastic left heart syndrome. Design: A f orced-choice questionnaire was sent to 108 US neonatology section head s. Responses were analyzed using Wilcoxon matched pairs, chi(2) analys is, and multivariant logistic regression. Results: Ninety-three questi onnaires (86%) were returned. All respondents discussed palliative sur gery or transplantation or both with parents; 71 (76%) of 93 also disc ussed comfort care. Nineteen (24%) of 80 recommended comfort care only , 51 (64%) of 80 recommended surgery only, and 10 (12%) of 80 recommen ded both. Of the 61 respondents recommending one or both surgical proc edures, palliative surgery was recommended by 44 and transplantation b y 33. Respondents perceived that transplantation was associated with a lower 1-year mortality than palliative surgery (P<.001) and with a be tter quality of life (P<.001). Conclusions: Palliative surgery and tra nsplantation are widely used to treat hypoplastic left heart syndrome. The continued availability of comfort care suggests that these surgic al procedures are still in transition from experimental technology to standard of care.