Md. Iannettoni et al., IMPROVING RESULTS WITH FIRST-STAGE PALLIATION FOR HYPOPLASTIC LEFT-HEART SYNDROME, Journal of thoracic and cardiovascular surgery, 107(3), 1994, pp. 934-940
Between January 1990 and February 1993, 73 patients underwent first-st
age reconstruction for hypoplastic left heart syndrome at the Universi
ty of Michigan Medical Center. During this period, surgical reconstruc
tion remained essentially constant and consisted of a pulmonary artery
-to-aorta anastomosis with allograft augmentation of the ascending, tr
ansverse, and proximal descending aorta, restriction of pulmonary bloo
d flow with a polytetrafluoroethylene shunt from the innominate artery
to the central pulmonary artery confluence, and atrial septectomy. Ho
spital survival was 62 of 73 patients, 85% (70% confidence limits: 80%
to 89%). These results stand in marked contrast to those obtained dur
ing the earlier years of our experience from 1986 to 1989 when only 21
of 50 patients (42%, 70% confidence limits: 35% to 49%) suvived (p =
0.001). Among the most recent group of patients, only 2 of 7 patients
older than 1 month of age at operation survived, whereas 60 of 66 (91%
, 70% confidence limits: 87% to 94%) patients younger than 1 month of
age survived (p = 0.0001). Anatomic subtype and ascending aortic diame
ter were not predictive of survival. Actuarial survivals for those pat
ients younger than 1 month of age at the first-stage operation, includ
ing hospital deaths and subsequent operative procedures, were 81%, 74%
, and 74% at 6 months, 1 year, and 2 years, respectively. These result
s indicate that survival for patients after first-stage reconstruction
for hypoplastic left heart syndrome has significantly improved in rec
ent years, Older age was a strong risk factor, with a hospital surviva
l of 91% for those patients undergoing first-stage palliation within t
he first month of life. These data have important implications for the
type of operative intervention and its timing.