caa a22 4500 445824212 CHVBK 20180317145254.0 cr unu---uuuuu 170323e20111001xx s 000 0 eng 10.1007/s00246-011-0017-6 doi (NATIONALLICENCE)springer-10.1007/s00246-011-0017-6 Hypoplastic Left Heart Syndrome and Aortic Atresia-Mitral Stenosis Variant: Role of Myocardial Protection Strategy and Impact of Ventriculo-coronary Connections After Stage I Palliation [Elektronische Daten] [Anastasios Polimenakos, Shyam Sathanandam, Tarek Husayni, Chawki El Zein, David Roberson, Michel Ilbawi] Aortic atresia-mitral stenosis (AA-MS) has been implicated as a determinant of outcome after Stage-1 palliation (S1P) in hypoplastic left heart syndrome (HLHS).Studies evaluating the association of AA-MS with ventriculo-coronary connections (VCC) and mortality report conflicting results. The significance of VCC, myocardial protection, and shunt strategy after S1P has yet to be determined. Between January 2005 and July 2009, 100 neonates with HLHS underwent S1P. Mitral and aortic valves and presence of VCC were assessed. Antegrade continuous cold blood cardioplegia was administered throughout the vast extent of the neo-aortic reconstruction. A right ventricle-to-pulmonary shunt was used for an ascending aortic diameter of 0.6mm/kg or less. Survival analysis was performed to determine predictors and assess impact of AA-MS and VCC on hospital and interstage mortality. Twenty-seven (of 100) patients had AA-MS. The mean age and weight at S1P were 6.5±2.8days and 3.09±0.47kg, respectively. VCC were found in 56% of AA-MS. Twenty-two had Norwood-Sano, 3 had classic Norwood, and 2 had hybrid S1P. VCC were associated with AA-MS, endocardial fibroelastosis, and ascending aortic size <2mm (P<0.05) but not higher mortality (P=ns). Operative and interstage survival for AA-MS after S1P was 85.2 and 71%, respectively (not statistically different compared to all other subtypes; P=ns). Actuarial survival after S1P at 1, 3, 6, 12, and 36months was 92.9±4.9, 78.6±7.8, 75±8.2, 71.3±8.3, and 71.3±8.3%, respectively. Intact atrial septum and post-S1P renal dysfunction (P<0.05) were independent predictors of hospital and interstage mortality. In patients with HLHS, AA-MS carries no survival disadvantage after S1P during the hospital and interstage period regardless of VCC. Intact atrial septum and post-S1P renal dysfunction predict early and interstage mortality. Myocardial protection and shunt strategy might influence the outcome in this HLHS variant. Springer Science+Business Media, LLC, 2011 Hypoplastic left heart syndrome nationallicence Anatomical subtypes nationallicence Myocardial protection nationallicence Mitral stenosis nationallicence Aortic atresia nationallicence Polimenakos Anastasios Division of Pediatric Cardiovascular Surgery, The Heart Institute for Children at Advocate Hope Children's Hospital, Oak Lawn, IL, USA aut Sathanandam Shyam Division of Pediatric Cardiovascular Surgery, The Heart Institute for Children at Advocate Hope Children's Hospital, Oak Lawn, IL, USA aut Husayni Tarek Division of Pediatric Cardiovascular Surgery, The Heart Institute for Children at Advocate Hope Children's Hospital, Oak Lawn, IL, USA aut El Zein Chawki Division of Pediatric Cardiovascular Surgery, The Heart Institute for Children at Advocate Hope Children's Hospital, Oak Lawn, IL, USA aut Roberson David Division of Pediatric Cardiovascular Surgery, The Heart Institute for Children at Advocate Hope Children's Hospital, Oak Lawn, IL, USA aut Ilbawi Michel Division of Pediatric Cardiovascular Surgery, The Heart Institute for Children at Advocate Hope Children's Hospital, Oak Lawn, IL, USA aut Pediatric Cardiology Springer-Verlag 32/7(2011-10-01), 929-939 0172-0643 32:7<929 2011 32 246 https://doi.org/10.1007/s00246-011-0017-6 text/html Onlinezugriff via DOI 1 research-article jats NATIONALLICENCE 856 40 https://doi.org/10.1007/s00246-011-0017-6 text/html Onlinezugriff via DOI NATIONALLICENCE 700 1- Polimenakos Anastasios Division of Pediatric Cardiovascular Surgery, The Heart Institute for Children at Advocate Hope Children's Hospital, Oak Lawn, IL, USA aut NATIONALLICENCE 700 1- Sathanandam Shyam Division of Pediatric Cardiovascular Surgery, The Heart Institute for Children at Advocate Hope Children's Hospital, Oak Lawn, IL, USA aut NATIONALLICENCE 700 1- Husayni Tarek Division of Pediatric Cardiovascular Surgery, The Heart Institute for Children at Advocate Hope Children's Hospital, Oak Lawn, IL, USA aut NATIONALLICENCE 700 1- El Zein Chawki Division of Pediatric Cardiovascular Surgery, The Heart Institute for Children at Advocate Hope Children's Hospital, Oak Lawn, IL, USA aut NATIONALLICENCE 700 1- Roberson David Division of Pediatric Cardiovascular Surgery, The Heart Institute for Children at Advocate Hope Children's Hospital, Oak Lawn, IL, USA aut NATIONALLICENCE 700 1- Ilbawi Michel Division of Pediatric Cardiovascular Surgery, The Heart Institute for Children at Advocate Hope Children's Hospital, Oak Lawn, IL, USA aut NATIONALLICENCE 773 0- Pediatric Cardiology Springer-Verlag 32/7(2011-10-01), 929-939 0172-0643 32:7<929 2011 32 246 Metadata rights reserved Springer special CC-BY-NC licence nationallicence BK010053 XK010053 XK010000 NATIONALLICENCE NATIONALLICENCE NL-springer