Diffusion of innovative approaches to managing hypoplastic left heart syndrome
W. D. Caplan, T. R. Cooper, J. A. Garcia-Prats and B. A. Brody
Department of Pediatrics, Baylor College of Medicine, Houston, Tex., USA.
OBJECTIVE: To study the perceptions of outcome and the diffusion into
practice of innovative approaches such as palliative surgery and heart
transplantation to treat hypoplastic left heart syndrome. DESIGN: A
forced-choice questionnaire was sent to 108 US neonatology section heads.
Responses were analyzed using Wilcoxon matched pairs, chi 2 analysis, and
multivariant logistic regression. RESULTS: Ninety-three questionnaires
(86%) were returned. All respondents discussed palliative surgery or
transplantation or both with parents; 71 (76%) of 93 also discussed comfort
care. Nineteen (24%) of 80 recommended comfort care only, 51 (64%) of 80
recommended surgery only, and 10 (12%) of 80 recommended both. Of the 61
respondents recommending one or both surgical procedures, palliative
surgery was recommended by 44 and transplantation by 33. Respondents
perceived that transplantation was associated with a lower 1-year mortality
than palliative surgery (P < .001) and with a better quality of life (P
< .001). CONCLUSIONS: Palliative surgery and transplantation are widely
used to treat hypoplastic left heart syndrome. The continued availability
of comfort care suggests that these surgical procedures are still in
transition from experimental technology to standard of care.
