{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,2]],"date-time":"2026-10-02T02:27:44Z","timestamp":1790908064991,"version":"4.1.0"},"reference-count":20,"publisher":"Springer Science and Business Media LLC","license":[{"start":{"date-parts":[[2026,1,24]],"date-time":"2026-01-24T00:00:00Z","timestamp":1769212800000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2026,1,24]],"date-time":"2026-01-24T00:00:00Z","timestamp":1769212800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["Pediatr Cardiol"],"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:p>\n                    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\u2009\u2264\u20092.5\u00a0kg or gestation\u2009\u2264\u200935 weeks, and age\u2009\u2264\u200930 days at admission were included (\n                    <jats:italic>N<\/jats:italic>\n                    \u2009=\u2009398). Norwood (\n                    <jats:italic>n<\/jats:italic>\n                    \u2009=\u2009225), hybrid (pulmonary artery band (PAB)\u2009+\u2009ductal stent,\n                    <jats:italic>n<\/jats:italic>\n                    \u2009=\u200976), and PAB with prostaglandin (PAB\/PGE,\n                    <jats:italic>n<\/jats:italic>\n                    \u2009=\u200977) were compared from the National Pediatric Cardiology Quality Improvement Collaborative database. Transplantation referral (\n                    <jats:italic>n<\/jats:italic>\n                    \u2009=\u20091) and comfort care (\n                    <jats:italic>n<\/jats:italic>\n                    \u2009=\u200919) 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,\n                    <jats:italic>p<\/jats:italic>\n                    \u2009=\u20090.03) and stage 2 completion (90% vs. 61% hybrid, 67% PAB\/PGE,\n                    <jats:italic>p<\/jats:italic>\n                    \u2009&lt;\u20090.001) than hybrid. In birthweight\u2009\u2264\u20092.12\u00a0kg, the survival advantage in Norwood was eliminated (59% for Norwood vs. 56% for hybrid and PAB\/PGE,\n                    <jats:italic>p<\/jats:italic>\n                    \u2009=\u20090.61). Hybrid (HR 2.8,\n                    <jats:italic>p<\/jats:italic>\n                    \u2009&lt;\u20090.001), genetic abnormality (HR 1.5,\n                    <jats:italic>p<\/jats:italic>\n                    \u2009=\u20090.03), and post stage 1 ECMO (HR: 7.2,\n                    <jats:italic>p<\/jats:italic>\n                    \u2009&lt;\u20090.001) were associated with decreased survival and stage 2 completion, while higher birth weight (HR: 1.5,\n                    <jats:italic>p<\/jats:italic>\n                    \u2009&lt;\u20090.001) was associated with increased stage 2 completion. Less than 25% of HR-SV with birthweight\u2009\u2264\u20092.12\u00a0kg and \u2265\u20091 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\u2009\u2264\u20092.1\u00a0kg and genetic abnormalities, both strategies offer low survival.\n                  <\/jats:p>","DOI":"10.1007\/s00246-026-04166-7","type":"journal-article","created":{"date-parts":[[2026,1,24]],"date-time":"2026-01-24T15:16:29Z","timestamp":1769267789000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":2,"title":["Hybrid vs. Norwood: An Analysis of the NPC-QIC Database to Determine Optimal Approach for High-Risk Single Ventricle Patients"],"prefix":"10.1007","author":[{"given":"Connor P.","family":"Callahan","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Paighton","family":"Miller","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Horacio","family":"Carvajal","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Fei","family":"Wan","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Matthew","family":"Canter","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Chelsea","family":"Mannie","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Garick D.","family":"Hill","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Pirooz","family":"Eghtesady","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2026,1,24]]},"reference":[{"key":"4166_CR1","doi-asserted-by":"publisher","first-page":"1099","DOI":"10.1161\/hc0902.104709","volume":"105","author":"H Akintuerk","year":"2002","unstructured":"Akintuerk H, Michel-Behnke I, Valeske K, Mueller M, Thul J, Bauer J et al (2002) Stenting of the arterial duct and banding of the pulmonary arteries: basis for combined Norwood stage I and II repair in hypoplastic left heart. Circulation 105:1099\u20131103. https:\/\/doi.org\/10.1161\/hc0902.104709","journal-title":"Circulation"},{"key":"4166_CR2","doi-asserted-by":"publisher","first-page":"163","DOI":"10.1016\/j.jtcvs.2005.07.053","volume":"131","author":"EA Bacha","year":"2006","unstructured":"Bacha EA, Daves S, Hardin J, Abdulla R, Anderson J, Kahana M et al (2006) Single-ventricle palliation for high-risk neonates: the emergence of an alternative hybrid stage I strategy. J Thorac Cardiovasc Surg 131:163\u2013171e2. https:\/\/doi.org\/10.1016\/j.jtcvs.2005.07.053","journal-title":"J Thorac Cardiovasc Surg"},{"key":"4166_CR3","doi-asserted-by":"publisher","first-page":"206","DOI":"10.1016\/j.jtcvs.2012.09.063","volume":"145","author":"KJ Guleserian","year":"2013","unstructured":"Guleserian KJ, Barker GM, Sharma MS, Macaluso J, Huang R, Nugent AW et al (2013) Bilateral pulmonary artery banding for resuscitation in high-risk, single-ventricle neonates and infants: a single-center experience. J Thorac Cardiovasc Surg 145:206\u2013213. https:\/\/doi.org\/10.1016\/j.jtcvs.2012.09.063","journal-title":"J Thorac Cardiovasc Surg"},{"key":"4166_CR4","doi-asserted-by":"publisher","first-page":"943","DOI":"10.1016\/j.jtcvs.2023.01.013","volume":"166","author":"MB Argo","year":"2023","unstructured":"Argo MB, Barron DJ, Eghtesady P, Alsoufi B, Honjo O, Yerebakan C et al (2023) Norwood operation versus comprehensive stage II after bilateral pulmonary artery banding palliation for infants with critical left heart obstruction. J Thorac Cardiovasc Surg 166:943\u2013954e1. https:\/\/doi.org\/10.1016\/j.jtcvs.2023.01.013","journal-title":"J Thorac Cardiovasc Surg"},{"key":"4166_CR5","doi-asserted-by":"publisher","first-page":"1300","DOI":"10.1016\/j.jtcvs.2023.04.022","volume":"166","author":"MB Argo","year":"2023","unstructured":"Argo MB, Barron DJ, Bondarenko I, Eckhauser A, Gruber PJ, Lambert LM et al (2023) Hybrid palliation versus nonhybrid management for a multi-institutional cohort of infants with critical left heart obstruction. J Thorac Cardiovasc Surg 166:1300\u20131313e2. https:\/\/doi.org\/10.1016\/j.jtcvs.2023.04.022","journal-title":"J Thorac Cardiovasc Surg"},{"key":"4166_CR6","doi-asserted-by":"publisher","first-page":"988","DOI":"10.1016\/j.athoracsur.2023.06.025","volume":"116","author":"HG Carvajal","year":"2023","unstructured":"Carvajal HG, Canter MW, Wan F, Eghtesady P (2023) Hypoplastic left heart syndrome with low birth weight or prematurity: what is the optimal approach? Ann Thorac Surg 116:988\u2013995. https:\/\/doi.org\/10.1016\/j.athoracsur.2023.06.025","journal-title":"Ann Thorac Surg"},{"key":"4166_CR7","doi-asserted-by":"publisher","first-page":"1849","DOI":"10.1016\/j.athoracsur.2019.06.061","volume":"108","author":"CT Sower","year":"2019","unstructured":"Sower CT, Romano JC, Yu S, Lowery R, Pasquali SK, Zampi JD (2019) Early and midterm outcomes in high-risk single-ventricle patients: hybrid vs Norwood palliation. Ann Thorac Surg 108:1849\u20131855. https:\/\/doi.org\/10.1016\/j.athoracsur.2019.06.061","journal-title":"Ann Thorac Surg"},{"key":"4166_CR8","doi-asserted-by":"publisher","first-page":"1291","DOI":"10.1016\/j.jtcvs.2021.11.103","volume":"164","author":"NM Ceneri","year":"2022","unstructured":"Ceneri NM, Desai MH, Tongut A, Ozturk M, Ramakrishnan K, Staffa SJ et al (2022) Hybrid strategy in neonates with ductal-dependent systemic circulation and multiple risk factors. J Thorac Cardiovasc Surg 164:1291\u20131303e6. https:\/\/doi.org\/10.1016\/j.jtcvs.2021.11.103","journal-title":"J Thorac Cardiovasc Surg"},{"key":"4166_CR9","doi-asserted-by":"publisher","first-page":"1189","DOI":"10.1161\/CIRCULATIONAHA.121.055183","volume":"144","author":"AB Ho","year":"2021","unstructured":"Ho AB, Hribernik I, Shillaker D, Thomson J, Salam A, Dedieu N et al (2021) Hybrid palliation for hypoplastic left heart syndrome: association with contemporary outcomes. Circulation 144:1189\u20131191. https:\/\/doi.org\/10.1161\/CIRCULATIONAHA.121.055183","journal-title":"Circulation"},{"key":"4166_CR10","doi-asserted-by":"publisher","first-page":"2063","DOI":"10.1016\/j.athoracsur.2008.02.009","volume":"85","author":"M Galantowicz","year":"2008","unstructured":"Galantowicz M, Cheatham JP, Phillips A, Cua CL, Hoffman TM, Hill SL et al (2008) Hybrid approach for hypoplastic left heart syndrome: intermediate results after the learning curve. Ann Thorac Surg 85:2063\u20132070. https:\/\/doi.org\/10.1016\/j.athoracsur.2008.02.009","journal-title":"Ann Thorac Surg"},{"key":"4166_CR11","doi-asserted-by":"publisher","first-page":"828","DOI":"10.1016\/j.athoracsur.2019.07.070","volume":"109","author":"J Tanem","year":"2020","unstructured":"Tanem J, Rudd N, Rauscher J, Scott A, Frommelt MA, Hill GD (2020) Survival after Norwood procedure in high-risk patients. Ann Thorac Surg 109:828\u2013833. https:\/\/doi.org\/10.1016\/j.athoracsur.2019.07.070","journal-title":"Ann Thorac Surg"},{"key":"4166_CR12","doi-asserted-by":"publisher","first-page":"613","DOI":"10.1016\/j.ejcts.2007.12.042","volume":"33","author":"C Pizarro","year":"2008","unstructured":"Pizarro C, Derby CD, Baffa JM, Murdison KA, Radtke WA (2008) Improving the outcome of high-risk neonates with hypoplastic left heart syndrome: hybrid procedure or conventional surgical palliation? Eur J Cardiothorac Surg 33:613\u2013618. https:\/\/doi.org\/10.1016\/j.ejcts.2007.12.042","journal-title":"Eur J Cardiothorac Surg"},{"key":"4166_CR13","doi-asserted-by":"publisher","first-page":"1519","DOI":"10.1016\/j.jtcvs.2013.11.053","volume":"148","author":"N Ota","year":"2014","unstructured":"Ota N, Murata M, Tosaka Y, Ide Y, Tachi M, Ito H et al (2014) Is routine rapid-staged bilateral pulmonary artery banding before stage 1 Norwood a viable strategy? J Thorac Cardiovasc Surg 148:1519\u20131525. https:\/\/doi.org\/10.1016\/j.jtcvs.2013.11.053","journal-title":"J Thorac Cardiovasc Surg"},{"key":"4166_CR14","doi-asserted-by":"publisher","first-page":"1777","DOI":"10.1016\/j.jtcvs.2014.02.066","volume":"147","author":"AA Brescia","year":"2014","unstructured":"Brescia AA, Jureidini S, Danon S, Armbrecht E, Fiore AC, Huddleston CB (2014) Hybrid versus Norwood procedure for hypoplastic left heart syndrome: contemporary series from a single center. J Thorac Cardiovasc Surg 147:1777\u20131782. https:\/\/doi.org\/10.1016\/j.jtcvs.2014.02.066","journal-title":"J Thorac Cardiovasc Surg"},{"key":"4166_CR15","doi-asserted-by":"publisher","first-page":"2286","DOI":"10.1016\/j.athoracsur.2015.06.098","volume":"100","author":"MO Murphy","year":"2015","unstructured":"Murphy MO, Bellsham-Revell H, Morgan GJ, Krasemann T, Rosenthal E, Qureshi SA et al (2015) Hybrid procedure for neonates with hypoplastic left heart syndrome at High-Risk for norwood: midterm outcomes. Ann Thorac Surg 100:2286\u20132290. https:\/\/doi.org\/10.1016\/j.athoracsur.2015.06.098","journal-title":"Ann Thorac Surg"},{"key":"4166_CR16","doi-asserted-by":"publisher","first-page":"139","DOI":"10.1016\/j.athoracsur.2019.07.062","volume":"109","author":"GD Hill","year":"2020","unstructured":"Hill GD, Tanem J, Ghanayem N, Rudd N, Ollberding NJ, Lavoie J et al (2020) Selective use of inpatient interstage management after Norwood procedure. Ann Thorac Surg 109:139\u2013147. https:\/\/doi.org\/10.1016\/j.athoracsur.2019.07.062","journal-title":"Ann Thorac Surg"},{"key":"4166_CR17","doi-asserted-by":"publisher","first-page":"163","DOI":"10.1016\/j.jtcvs.2016.08.021","volume":"153","author":"TJ Wilder","year":"2017","unstructured":"Wilder TJ, McCrindle BW, Hickey EJ, Ziemer G, Tchervenkov CI, Jacobs ML et al (2017) Is a hybrid strategy a lower-risk alternative to stage 1 Norwood operation? J Thorac Cardiovasc Surg 153:163\u2013172e6. https:\/\/doi.org\/10.1016\/j.jtcvs.2016.08.021","journal-title":"J Thorac Cardiovasc Surg"},{"key":"4166_CR18","doi-asserted-by":"publisher","first-page":"195","DOI":"10.1016\/j.jtcvs.2014.08.020","volume":"149","author":"T Karamlou","year":"2015","unstructured":"Karamlou T, Overman D, Hill KD, Wallace A, Pasquali SK, Jacobs JP et al (2015) Stage 1 hybrid palliation for hypoplastic left heart syndrome\u2013assessment of contemporary patterns of use: an analysis of the society of thoracic surgeons congenital heart surgery database. J Thorac Cardiovasc Surg 149:195\u2013201. https:\/\/doi.org\/10.1016\/j.jtcvs.2014.08.020","journal-title":"J Thorac Cardiovasc Surg"},{"key":"4166_CR19","doi-asserted-by":"publisher","first-page":"158","DOI":"10.1007\/s11748-007-0207-6","volume":"56","author":"T Sasaki","year":"2008","unstructured":"Sasaki T, Takahashi Y, Ando M, Wada N, Kawase Y, Seki H (2008) Bilateral pulmonary artery banding for hypoplastic left heart syndrome and related anomalies. Gen Thorac Cardiovasc Surg 56:158\u2013162. https:\/\/doi.org\/10.1007\/s11748-007-0207-6","journal-title":"Gen Thorac Cardiovasc Surg"},{"key":"4166_CR20","doi-asserted-by":"publisher","first-page":"885","DOI":"10.1016\/j.athoracsur.2013.05.049","volume":"96","author":"RA Russell","year":"2013","unstructured":"Russell RA, Ghanayem NS, Mitchell ME, Woods RK, Tweddell JS (2013) Bilateral pulmonary artery banding as rescue intervention in high-risk neonates. Ann Thorac Surg 96:885\u2013890. https:\/\/doi.org\/10.1016\/j.athoracsur.2013.05.049","journal-title":"Ann Thorac Surg"}],"container-title":["Pediatric Cardiology"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1007\/s00246-026-04166-7.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/article\/10.1007\/s00246-026-04166-7","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1007\/s00246-026-04166-7.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,1,24]],"date-time":"2026-01-24T15:16:30Z","timestamp":1769267790000},"score":1,"resource":{"primary":{"URL":"https:\/\/link.springer.com\/10.1007\/s00246-026-04166-7"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,1,24]]},"references-count":20,"alternative-id":["4166"],"URL":"https:\/\/doi.org\/10.1007\/s00246-026-04166-7","relation":{},"ISSN":["0172-0643","1432-1971"],"issn-type":[{"value":"0172-0643","type":"print"},{"value":"1432-1971","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,1,24]]},"assertion":[{"value":"29 October 2025","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"13 January 2026","order":2,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"24 January 2026","order":3,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"order":1,"name":"Ethics","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"The authors declare no competing interests.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Conflict of interest"}}]}}