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J Am Coll Cardiol. 2001 Oct;38(4):1181-7.

A comparison of treatment strategies for hypoplastic left heart syndrome using decision analysis.

Author information

1
Department of Pediatrics, Dartmouth Medical School, Hanover, New Hampshire 03755, USA. pcj@hitchcock.org

Abstract

OBJECTIVES:

We sought to identify the optimal treatment strategy for hypoplastic left heart syndrome (HLHS).

BACKGROUND:

Surgical treatment of HLHS involves either transplantation (Tx) or staged palliation of the native heart. Identifying the best treatment for HLHS requires integrating individual patient risk factors and center-specific data.

METHODS:

Decision analysis is a modeling technique used to compare six strategies: staged surgery; Tx; stage 1 surgery as an interim to Tx; and listing for transplant for one, two, or three months before performing staged surgery if a donor is unavailable. Probabilities were derived from current literature and a dataset of 231 patients with HLHS born between 1989 and 1994. The goal was to maximize first-year survival.

RESULTS:

If a donor is available within one month, Tx is the optimal choice, given baseline probabilities; if no donor is found by the end of one month, stage 1 surgery should be performed. When survival and organ donation probabilities were varied, staged surgery was the optimal choice for centers with organ donation rates < 10% in three months and with stage 1 mortality <20%. Waiting one month on the transplant list optimized survival when the three-month organ donation rate was > or =30%. Performing stage 1 surgery before listing, or performing stage 1 surgery after an unsuccessful two- or three-month wait for transplant, were almost never optimal choices.

CONCLUSIONS:

The best strategy for centers that treat patients with HLHS should be guided by local organ availability, stage 1 surgical mortality and patient risk factors.

PMID:
11583901
[Indexed for MEDLINE]
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