O-2
Timing of Balloon Atrial Septostomy and Outcomes in Hybrid Stage 1 Palliation for Hypoplastic Left Heart Syndrome
Presenter
William Fogarty IV, DO, Nationwide Children's Hospital, Columbus, OH
William Fogarty IV, DO1, Christina Phelps, MD2, Mark E. Galantowicz, M.D., FSCAI1, Arash Salavitabar, M.D., FSCAI1, Benjamin Blais, MD1, Robin Alexander, MS3, Chance Alvarado, MS3, Karen Texter, MD1 and Aimee K. Armstrong, M.D., FSCAI1, (1)Nationwide Children's Hospital, Columbus, OH, (2)Children's Hospital Colorado, Denver, CO, (3)Biostatistics Resource at Nationwide Children's Hospital, Columbus, OH
Keywords: Atrial Septal Defect (ASD) and Congenital Heart Disease (CHD)
Background
Transcatheter balloon atrial septostomy (BAS) is often completed to enlarge the atrial septal defect in patients with hypoplastic left heart syndrome (HLHS) palliated with a hybrid stage 1 (HS1) procedure. The optimal timing of the BAS in relation to the HS1 has not been discussed in the literature. The timing of BAS at our institution has been variable and based on anecdotal experiences. We hypothesized that same day completion of the BAS and HS1 would decrease hospital length of stay, increase ICU-free days, improve hemodynamic markers of cardiac function, and increase transplant-free survival during the first year of life.
Methods
We retrospectively reviewed HLHS patients palliated with HS1 from January 2009 to July 2022 at our center. We excluded other single ventricle variants, those not initially palliated with HS1, those who did not have a BAS or had it performed prior to the HS1, and those with an initial atrial septal intervention other than BAS. Patients were divided into two groups: those who had the BAS and HS1 performed together (Group 1) and those who had the BAS performed
> 1 day after the HS1 (Group 2).
Results
We identified 118 HLHS patients who underwent HS1 palliation, 92 of whom met inclusion criteria, including 22 (23.9%) in Group 1. Demographic data between the groups were not statistically different. Median BAS timing after HS1 for Group 2 was 9 days (p<0.001). Group 1 had significantly lower hospital length of stay (17 vs 27 days, p<0.001), higher recorded cerebral near infrared spectroscopy (NIRS) troughs (51% vs 45%, p=0.02), and lower 30-day post-BAS/discharge brain natriuretic peptide levels (257 vs 825 pg/mL, p<0.001) compared to Group 2. ICU-free days trended greater in Group 1 (19 vs 16 days, p=0.15), and the proportion of patients with greater than 15 ICU-free days during the indexed admission was greater in Group 1 (72.7% vs 48.6%, p=0.05). There was no difference in 30-day or 1-year mortality, but Group 1 had higher median hospital-free days at 1 year of age compared to Group 2 (321 vs 267 days, p=0.05).
Conclusions
Same day completion of BAS and HS1 in HLHS patients resulted in shorter hospital length of stay, improved hemodynamic markers of cardiac function, and more ICU/hospital-free days experienced.