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Current Anesthesiology Reports

Erschienen in:

09.05.2019 | Pediatric Anesthesia (J Lerman, Section Editor)

Stage 1 Palliation of Hypoplastic Left Heart Syndrome: What the Pediatric Anesthesiologist Needs to Know

verfasst von: Dawn M. Sweeney, Jane Arcadi

Erschienen in: Current Anesthesiology Reports | Ausgabe 2/2019

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Abstract

Purpose of Review

The purpose of this review is to discuss the features of stage 1 palliation of hypoplastic left heart syndrome (HLHS). Comparison will be made between traditional surgical approaches and hybrid approaches. Anesthetic considerations for infants with these types of palliations will be discussed.

Recent Findings

While historically surgical palliation in the neonatal period or neonatal heart transplant has been the primary means of survival for neonates with HLHS, in the last two decades, more centers have been performing hybrid palliation of this defect. This palliation can be performed with the expectation that a comprehensive second-stage palliation will be done in the next several months, or it can be used as a bridge to transplant. Other uses are also being explored as research continues.

Summary

Advances in the care of neonates with HLHS have led to increased survival. As surgical technique and non-surgical care of these infants continue to improve, the pediatric anesthesiologist will need to be familiar with the anatomic and physiologic implications of the various types of palliation.

Norwood WI, Kirklin JK, Sanders SP. Hypoplastic left heart syndrome: experience with palliative surgery. Am J Cardiol. 1980;45(1):87–91.CrossRef

Bailey LL, Nehlsen-Cannarella SL, Concepcion W, Jolley WB. Baboon-to-human cardiac xenotransplantation in a neonate. JAMA. 1985;254(23):3321–9.CrossRef

Norwood WI, Lang P, Hansen DD. Physiologic repair of aortic atresia-hypoplastic left heart syndrome. N Engl J Med. 1983;308(1):23–6.CrossRef

Sano S, Ishino K, Kawada M, Arai S, Kasahara S, Asai T, et al. Right ventricle-pulmonary artery shunt in first-stage palliation of hypoplastic left heart syndrome. J Thorac Cardiovasc Surg. 2003;126(2):504–9.CrossRef

Gibbs JL, Wren C, Watterson KG, Hunter S, Hamilton JR. Stenting of the arterial duct combined with banding of the pulmonary arteries and atrial septectomy or septostomy: a new approach to palliation for the hypoplastic left heart syndrome. Br Heart J. 1993;69(6):551–5.CrossRef

•• Haller C, Caldarone CA. The evolution of therapeutic strategies: niche apportionment for hybrid palliation. Ann Thorac Surg. 2018;106(6):1873–80. https://doi.org/10.1016/j.athoracsur.2018.05.048Comprehensive yet very readable article outlining the potential, uses, and variations of the hybrid procedure. CrossRefPubMed

Baba K, Honjo O, Chaturvedi R, Lee KJ, Van Arsdell G, Caldarone CA, et al. “Reverse Blalock-Taussig shunt”: application in single ventricle hybrid palliation. J Thorac Cardiovasc Surg. 2013;146(2):352–7. https://doi.org/10.1016/j.jtcvs.2012.11.029. Epub 2012 Dec 8.CrossRefPubMed

Caldarone CA, Benson LN, Holtby H, Van Arsdell GS. Main pulmonary artery to innominate artery shunt during hybrid palliation of hypoplastic left heart syndrome. J Thorac Cardiovasc Surg. 2005;130(4):e1–2.CrossRef

Briceno-Medina M, Kumar TKS, Sathanandam S, Boston U, Perez M, Allen J, et al. Femoral vein homograft as Sano shunt results in improved pulmonary artery growth after Norwood operation. Cardiol Young. 2018;28(1):118–25. https://doi.org/10.1017/S1047951117001688.CrossRefPubMed

10.

Nwankwo UT, Morell EM, Trucco SM, Morell VO, Kreutzer J. Hybrid strategy for neonates with ductal-dependent systemic circulation at high risk for Norwood. Ann Thorac Surg. 2018;106(2):595–601. https://doi.org/10.1016/j.athoracsur.2018.03.007.CrossRefPubMed

11.

Brescia AA, Jureidini S, Danon S, Armbrecht E, Fiore AC, Huddleston CB. Hybrid versus Norwood procedure for hypoplastic left heart syndrome: contemporary series from a single center. J Thorac Cardiovasc Surg. 2014;147(6):1777–82. https://doi.org/10.1016/j.jtcvs.2014.02.066.CrossRefPubMed

12.

•• Lloyd DF, Rutherford MA, Simpson JM, Razavi R. The neurodevelopmental implications of hypoplastic left heart syndrome in the fetus. Cardiol Young. 2017;27(2):217–23. https://doi.org/10.1017/S1047951116001645This is the only article I have seen looking at fetal neurodevelopment in hypoplastic left heart syndrome. There is a good discussion of abnormalities of cerebral blood flow in fetuses with HLHS. CrossRefPubMed

13.

• Diaz LK, Gaynor JW, Koh SJ, Ittenbach RF, Gerdes M, Bernbaum JC, et al. Increasing cumulative exposure to volatile anesthetic agents is associated with poorer neurodevelopmental outcomes in children with hypoplastic left heart syndrome. J Thorac Cardiovasc Surg. 2016;152(2):482–9. https://doi.org/10.1016/j.jtcvs.2016.03.095This is the only paper that looks at cumulative exposure to volatile anesthetics in HLHS specifically. While there are no definitive answers on the subject, anesthesiologists need to remain vigilant in the care of these infants who may be at risk for poorer neurodevelopmental outcomes. CrossRefPubMedPubMedCentral

14.

• Yerebakan C, Valeske K, Elmontaser H, Yörüker U, Mueller M, Thul J, Mann V, Latus H, Villanueva A, Hofmann K, Schranz D, Akintuerk H. Hybrid therapy for hypoplastic left heart syndrome: myth, alternative, or standard? J Thorac Cardiovasc Surg. 2016;151(4):1112–21, 1123.e1-5. https://doi.org/10.1016/j.jtcvs.2015.10.066. This article discusses in detail the re-interventions commonly needed after hybrid palliation. The discussion section provides further insight into this issue.

15.

Mosca RS. Hybrid therapy for hypoplastic left heart syndrome: myth, alternative, or standard—neither minotaur nor Midas. J Thorac Cardiovasc Surg. 2016;151(4):1123–5. https://doi.org/10.1016/jtcvs.2015.10.099 Epub 2015Oct 30.CrossRefPubMed

16.

•• Ohye RG, Schranz D, D'Udekem Y. Current therapy for hypoplastic left heart syndrome and related single ventricle lesions. Circulation. 2016;134(17):1265–79 Excellent review of therapy for HLHS, including all 3 stages of palliation. CrossRef

17.

Watkins SC, McNew BS, Donahue BS. Risks of noncardiac operations and other procedures in children with complex congenital heart disease. Ann Thorac Surg. 2013;95:2014–1.CrossRef

18.

Mittnacht AJC. Near infrared spectroscopy in children at high risk of low perfusion. Curr Opin Anaesthesiol. 2010;23:342–7.CrossRef

19.

Galantowicz M, Cheatham JP, Phillips A, Cua CL, Hoffman TM, Hill SL, et al. Hybrid approach for hypoplastic left heart syndrome: intermediate results after the learning curve. Ann Thorac Surg. 2008;85(6):2063–70. https://doi.org/10.1016/j.athoracsur.2008.02.009.CrossRefPubMed

20.

Cheatham SL, Carey H, Chisolm JL, Heathcock JC, Steward D. Early results of neurodevelopment following hybrid stage I for hypoplastic left heart syndrome. Pediatr Cardiol. 2015;36(3):685–91. https://doi.org/10.1007/s00246-014-1065-5.CrossRefPubMed

21.

Knirsch W, Liamlahi R, Hug MI, Hoop R, von Rhein M, Prêtre R, et al. Mortality and neurodevelopmental outcome at 1 year of age comparing hybrid and Norwood procedures. Eur J Cardiothorac Surg. 2012;42(1):33–9. https://doi.org/10.1093/ejcts/ezr286.CrossRefPubMed

22.

Malik S, Bird TM, Jaquiss RD, Morrow WR, Robbins JM. Comparison of in-hospital and longer-term outcomes of hybrid and Norwood stage 1 palliation of hypoplastic left heart syndrome. J Thorac Cardiovasc Surg. 2015;150(3):474–80.e2. https://doi.org/10.1016/j.jtcvs.2015.06.071.CrossRefPubMed

23.

•• Cao JY, Lee SY, Phan K, Ayer J, Celermajer DS, Winlaw DS. Early outcomes of hypoplastic left heart syndrome infants: meta-analysis of studies comparing the hybrid and Norwood procedures. World J Pediatr Congenit Heart Surg. 2018;9(2):224–33. https://doi.org/10.1177/2150135117752896This is the only meta-analysis specifically comparing the Norwood procedure with the hybrid procedure. CrossRefPubMed

24.

Murphy MO, Bellsham-Revell H, Morgan GJ, Krasemann T, Rosenthal E, Qureshi SA, et al. Hybrid procedure for neonates with hypoplastic left heart syndrome at high- risk for Norwood: midterm outcomes. Ann Thorac Surg. 2015;100(6):2286–90; Discussion 2291-2. https://doi.org/10.1016/j.athoracsur.2015.06.098.CrossRefPubMed

25.

•• TJ W, McCrindle BW, Hickey EJ, Ziemer G, Tchervenkov CI, Jacobs ML, et al. Is a hybrid strategy a lower-risk alternative to stage 1 Norwood operation? J Thorac Cardiovasc Surg. 2017;153(1):163–172.e6. https://doi.org/10.1016/j.jtcvs.2016.08.021This article compares both conventional Norwood procedures and those with the RV to PA conduit modification to the hybrid procedure. Most papers do not compare all 3 types of palliation. CrossRef

26.

• Cleveland D, Adam Banks C, Hara H, Carlo WF, Mauchley DC, DKC C. The case for cardiac xenotransplantation in neonates: is now the time to reconsider xenotransplantation for hypoplastic left heart syndrome? Pediatr Cardiol. 2019;40(2):437–44. https://doi.org/10.1007/s00246-018-1998-1Interesting article about a possible future of cardiac transplantation in neonates that discusses genetic engineering and xenotransplantation. CrossRefPubMed

27.

Wilder TJ. Redefining successful outcomes in the hybrid era. World J Pediatr Congenit.

28.

Naguib AN, Winch P, Schwartz L, Isaacs J, Rodeman R, Cheatham JP, et al. Anesthetic management of the hybrid stage 1 procedure for hypoplastic left heart syndrome (HLHS). Paediatr Anaesth. 2010;20(1):38–46. https://doi.org/10.1111/j.1460-9592.2009.03205.x.CrossRefPubMed

Titel: Stage 1 Palliation of Hypoplastic Left Heart Syndrome: What the Pediatric Anesthesiologist Needs to Know
verfasst von: Dawn M. Sweeney
Jane Arcadi
Publikationsdatum: 09.05.2019
Verlag: Springer US
Erschienen in: Current Anesthesiology Reports / Ausgabe 2/2019
Elektronische ISSN: 2167-6275
DOI: https://doi.org/10.1007/s40140-019-00329-w

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Stage 1 Palliation of Hypoplastic Left Heart Syndrome: What the Pediatric Anesthesiologist Needs to Know

Abstract

Purpose of Review

Recent Findings

Summary

Neu im Fachgebiet AINS

Stereotaktische Radiatio schlägt konventionelle Bestrahlung

Fünf Dinge, die im Kindernotfall besser zu unterlassen sind

Hochrisiko-Eingriffe für postoperative Übelkeit

Diclofenac-Gel versus Ibuprofen bei akuten Rückenschmerzen

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Live-Webinar: Aktuelle Leitlinien bei Herz-Kreislauf-Erkrankungen

Springer Medizin

Abstract

Purpose of Review

Recent Findings

Summary

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