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Practice variation using the hybrid stage I procedure in congenital heart disease: Results from a national surveyCentral MessagePerspective
- Source :
- JTCVS Open, Vol 21, Iss , Pp 248-256 (2024)
- Publication Year :
- 2024
- Publisher :
- Elsevier, 2024.
-
Abstract
- Objectives: Hybrid stage I palliation has been used in many clinical scenarios including initial palliation in single ventricle heart disease, a bridge to biventricular repair, a bridge to transplant, and as a destination therapy. There is considerable hybrid stage I palliation practice variation, which we aimed to better understand in this study. Methods: Survey-based assessment of practice variation related to hybrid stage I palliation was sent to congenital heart centers across the United States and Canada. Results: Of the 106 centers surveyed, responses were received from 54 centers (50.9%). Of respondents, 45 centers perform hybrid stage I palliation. Centers most commonly (97.7%) perform hybrid stage I palliation on “high-risk” patients with single ventricle heart disease. Regarding the technical aspects of hybrid stage I palliation, most centers (95.3%) accomplish restrictive pulmonary blood flow using pulmonary artery bands and primarily use changes in oxygen saturation (34.1%) to identify appropriate restriction. Ductal stents are most often used (67.4%) to maintain ductal patency. Only 10 centers (23.3%) routinely enlarge the atrial septal defect. Indications for atrial septal defect intervention varied widely. Most centers (71.9%) discharge patients home to follow with a formal “interstage” program. Conclusions: There is significant variation in practice patterns for hybrid stage I palliation indications, technical aspects, and postoperative care. Therefore, generalizability of single-center studies on outcomes after hybrid stage I palliation is limited. Future multicenter studies are needed to best delineate which patients benefit most from hybrid stage I palliation and to further define optimal approaches to caring for these patients.
Details
- Language :
- English
- ISSN :
- 26662736
- Volume :
- 21
- Issue :
- 248-256
- Database :
- Directory of Open Access Journals
- Journal :
- JTCVS Open
- Publication Type :
- Academic Journal
- Accession number :
- edsdoj.19fc8b2713a4eb7aac7993305a3ed94
- Document Type :
- article
- Full Text :
- https://doi.org/10.1016/j.xjon.2024.07.020