Achieving Benchmark Results for Neonatal Palliation of XXXX and @entity154 in an Emerging Program.

@entity1 @entity154 @entity1700 @entity1699 @entity3885 @entity3009 @entity338 @entity2333
BACKGROUND: Results of surgical management of @entity1699 ( @entity1699 ) and @entity154 are often compared to published benchmark data which reflect the use of a variety of surgical and hybrid protocols. We report encouraging results achieved in an emerging program, despite a learning curve at all care levels. Rather than relying on a single preferred protocol, surgical management was based on matching surgical strategy to individual @entity1 factors. METHODS: From 2010 to 2014, a total of 47 consecutive @entity1 with @entity1699 or @entity154 with ductal-dependent systemic circulation underwent initial surgical palliation, including 30 Norwood stage I, 8 hybrid stage I, and 9 salvage-to-Norwood procedures. True hybrid procedures entailed bilateral pulmonary artery banding and ductal stenting. In the salvage-to-Norwood strategy, ductal stenting was withheld in favor of continued @entity3009 infusion in anticipation of a deferred Norwood procedure. Cardiac comorbidities (obstructed @entity1700 , poor ventricular function, and @entity338 ) and noncardiac comorbidities influenced the choice of treatment strategies and were analyzed as potential risk factors for extracorporeal membrane oxygenation (ECMO) support or in-hospital mortality. RESULTS: Overall hospital survival was 81% (Norwood 83.3%, hybrid 88%, "salvage" 67%; P = .4942). Extracorporeal membrane oxygenation support was used for eight (17%) @entity1 with two survivors. For cases with obstructed @entity1700 (n = 10, 21%), management choices favored a hybrid or salvage strategy (P = .0026). @entity2333 (n = 22, 47%) was treated by a Norwood or salvage-to-Norwood. No cardiac, noncardiac, or genetic comorbidities were identified as independent risk factors for ECMO or discharge mortality in a multivariable analysis. CONCLUSIONS: Our emerging program achieved outcomes that compare favorably to published benchmark data with respect to hospital survival. These results reflect rigorous interdisciplinary teamwork and a flexible approach to surgical palliation based on matching surgical strategy to @entity1 factors. With major associated cardiac/noncardiac comorbidity and antegrade coronary flow, a true hybrid with ductal stenting was our preferred strategy. For high-risk situations such as @entity3885 , the salvage hybrid-bridge-to-Norwood strategy may help achieve survival albeit with increased resource utilization.
