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<p>We sought to identify the optimal management strategy of infants with high-risk hypoplastic left heart syndrome and variants (HR-SV) and identify factors associated with futility. Patients with birth weight ≤ 2.5&#xa0;kg or gestation ≤ 35 weeks, and age ≤ 30 days at admission were included (<i>N</i> = 398). Norwood (<i>n</i> = 225), hybrid (pulmonary artery band (PAB) + ductal stent, <i>n</i> = 76), and PAB with prostaglandin (PAB/PGE, <i>n</i> = 77) were compared from the National Pediatric Cardiology Quality Improvement Collaborative database. Transplantation referral (<i>n</i> = 1) and comfort care (<i>n</i> = 19) occurred. Baseline factors, 1-year survival, and stage 2 completion were reviewed. Norwood had higher gestational age, birth weight, and younger age at intervention than hybrid and PAB/PGE; while more PAB/PGE and hybrid had chromosomal and other organ abnormalities. Norwood had higher survival (70% vs. 54% hybrid, 55% PAB/PGE, <i>p</i> = 0.03) and stage 2 completion (90% vs. 61% hybrid, 67% PAB/PGE, <i>p</i> &lt; 0.001) than hybrid. In birthweight ≤ 2.12&#xa0;kg, the survival advantage in Norwood was eliminated (59% for Norwood vs. 56% for hybrid and PAB/PGE, <i>p</i> = 0.61). Hybrid (HR 2.8, <i>p</i> &lt; 0.001), genetic abnormality (HR 1.5, <i>p</i> = 0.03), and post stage 1 ECMO (HR: 7.2, <i>p</i> &lt; 0.001) were associated with decreased survival and stage 2 completion, while higher birth weight (HR: 1.5, <i>p</i> &lt; 0.001) was associated with increased stage 2 completion. Less than 25% of HR-SV with birthweight ≤ 2.12&#xa0;kg and ≥ 1 genetic abnormality was alive with stage 2 at end of follow-up. HR-SV have better outcomes following Norwood than hybrid. In patients with birth weight ≤ 2.1&#xa0;kg and genetic abnormalities, both strategies offer low survival.</p>

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Hybrid vs. Norwood: An Analysis of the NPC-QIC Database to Determine Optimal Approach for High-Risk Single Ventricle Patients

  • 期刊论文

  • 出版模式：

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  • 发表日期：

    2026年1月24日

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  • Connor P. Callahan,
  • Paighton Miller,
  • Horacio Carvajal,
  • Fei Wan,
  • Matthew Canter,
  • Chelsea Mannie,
  • Garick D. Hill,
  • Pirooz Eghtesady

摘要

We sought to identify the optimal management strategy of infants with high-risk hypoplastic left heart syndrome and variants (HR-SV) and identify factors associated with futility. Patients with birth weight ≤ 2.5 kg or gestation ≤ 35 weeks, and age ≤ 30 days at admission were included (N = 398). Norwood (n = 225), hybrid (pulmonary artery band (PAB) + ductal stent, n = 76), and PAB with prostaglandin (PAB/PGE, n = 77) were compared from the National Pediatric Cardiology Quality Improvement Collaborative database. Transplantation referral (n = 1) and comfort care (n = 19) occurred. Baseline factors, 1-year survival, and stage 2 completion were reviewed. Norwood had higher gestational age, birth weight, and younger age at intervention than hybrid and PAB/PGE; while more PAB/PGE and hybrid had chromosomal and other organ abnormalities. Norwood had higher survival (70% vs. 54% hybrid, 55% PAB/PGE, p = 0.03) and stage 2 completion (90% vs. 61% hybrid, 67% PAB/PGE, p < 0.001) than hybrid. In birthweight ≤ 2.12 kg, the survival advantage in Norwood was eliminated (59% for Norwood vs. 56% for hybrid and PAB/PGE, p = 0.61). Hybrid (HR 2.8, p < 0.001), genetic abnormality (HR 1.5, p = 0.03), and post stage 1 ECMO (HR: 7.2, p < 0.001) were associated with decreased survival and stage 2 completion, while higher birth weight (HR: 1.5, p < 0.001) was associated with increased stage 2 completion. Less than 25% of HR-SV with birthweight ≤ 2.12 kg and ≥ 1 genetic abnormality was alive with stage 2 at end of follow-up. HR-SV have better outcomes following Norwood than hybrid. In patients with birth weight ≤ 2.1 kg and genetic abnormalities, both strategies offer low survival.