{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,8]],"date-time":"2026-05-08T02:00:20Z","timestamp":1778205620408,"version":"3.51.4"},"reference-count":18,"publisher":"Oxford University Press (OUP)","issue":"4","license":[{"start":{"date-parts":[[2024,3,29]],"date-time":"2024-03-29T00:00:00Z","timestamp":1711670400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/academic.oup.com\/pages\/standard-publication-reuse-rights"}],"funder":[{"name":"Endowed Chair in Cardiac Surgery"},{"name":"Thomas L. Spray, MD Endowed Chair in Paediatric Cardiothoracic Surgery"},{"name":"Daniel M. Tabas Endowed Chair in Paediatric Cardiothoracic Surgery at the Children\u2019s Hospital of Philadelphia"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2024,3,29]]},"abstract":"<jats:title>Abstract<\/jats:title>\n               <jats:p\/>\n               <jats:sec>\n                  <jats:title>OBJECTIVES<\/jats:title>\n                  <jats:p>The primary objectives were to examine utilization of the Hybrid versus the Norwood procedure for patients with hypoplastic left heart syndrome or variants and the impact on hospital mortality. The Hybrid procedure was 1st used at our institution in 2004.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>METHODS<\/jats:title>\n                  <jats:p>Review of all subjects undergoing the Norwood or Hybrid procedure between 1 January 1984 and 31 December 2022. The study period was divided into 8 eras: era 1, 1984\u20131988; era 2, 1989\u20131993; era 3, 1994\u20131998; era 4, 1999\u20132003; era 5, 2004\u20132008; era 6, 2009\u20132014; era 7, 2015\u20132018 and era 8, 2019\u20132022. The primary outcome was in-hospital mortality. Mortality rates were computed using standard binomial proportions with 95% confidence intervals. Rates across eras were compared using an ordered logistic regression model with and adjusted using the Tukey\u2013Kramer post-hoc procedure for multiple comparisons. In the risk-modelling phase, logistic regression models were specified and tested.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>RESULTS<\/jats:title>\n                  <jats:p>The Norwood procedure was performed in 1899 subjects, and the Hybrid procedure in 82 subjects. Use of the Hybrid procedure increased in each subsequent era, reaching 30% of subjects in era 8. After adjustment for multiple risk factors, use of the Hybrid procedure was significantly and positively associated with hospital mortality.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>CONCLUSIONS<\/jats:title>\n                  <jats:p>Despite the increasing use of the Hybrid procedure, overall mortality for the entire cohort has plateaued. After adjustment for risk factors, use of the Hybrid procedure was significantly and positively associated with mortality compared to the Norwood procedure.<\/jats:p>\n               <\/jats:sec>","DOI":"10.1093\/ejcts\/ezae164","type":"journal-article","created":{"date-parts":[[2024,4,11]],"date-time":"2024-04-11T15:43:15Z","timestamp":1712850195000},"source":"Crossref","is-referenced-by-count":3,"title":["Increased utilization of the hybrid procedure is not associated with improved early survival for newborns with hypoplastic left heart syndrome: a single-centre experience"],"prefix":"10.1093","volume":"65","author":[{"given":"Jonathan M","family":"Chen","sequence":"first","affiliation":[{"name":"Division of Cardiothoracic Surgery, Department of Surgery, Children\u2019s Hospital of Philadelphia, Perelman School of Medicine, University of Pennsylvania , Philadelphia, PA, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Richard F","family":"Ittenbach","sequence":"additional","affiliation":[{"name":"Division of Biostatistics and Epidemiology, Cincinnati Children\u2019s Hospital Medical Center , Cincinnati, OH, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Kendall M","family":"Lawrence","sequence":"additional","affiliation":[{"name":"Division of Cardiothoracic Surgery, Department of Surgery, Hospital of the University of Pennsylvania, Perelman School of Medicine, University of Pennsylvania , Philadelphia, PA, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Mallory L","family":"Hunt","sequence":"additional","affiliation":[{"name":"Division of Cardiothoracic Surgery, Department of Surgery, Hospital of the University of Pennsylvania, Perelman School of Medicine, University of Pennsylvania , Philadelphia, PA, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Michelle","family":"Kaplinski","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Lucile Packard Children\u2019s Hospital Stanford , Palo Alto, CA, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Marlene","family":"Mahle","sequence":"additional","affiliation":[{"name":"Division of Cardiothoracic Surgery, Department of Surgery, Children\u2019s Hospital of Philadelphia, Perelman School of Medicine, University of Pennsylvania , Philadelphia, PA, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Stephanie","family":"Fuller","sequence":"additional","affiliation":[{"name":"Division of Cardiothoracic Surgery, Department of Surgery, Children\u2019s Hospital of Philadelphia, Perelman School of Medicine, University of Pennsylvania , Philadelphia, PA, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Katsuhide","family":"Maeda","sequence":"additional","affiliation":[{"name":"Division of Cardiothoracic Surgery, Department of Surgery, Children\u2019s Hospital of Philadelphia, Perelman School of Medicine, University of Pennsylvania , Philadelphia, PA, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Muhammad A K","family":"Nuri","sequence":"additional","affiliation":[{"name":"Division of Cardiothoracic Surgery, Department of Surgery, Children\u2019s Hospital of Philadelphia, Perelman School of Medicine, University of Pennsylvania , Philadelphia, PA, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Monique M","family":"Gardner","sequence":"additional","affiliation":[{"name":"Division of Cardiac Critical Care Medicine, Department of Anesthesia Children\u2019s Hospital of Philadelphia, Perelman School of Medicine, University of Pennsylvania , Philadelphia, PA, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Constantine D","family":"Mavroudis","sequence":"additional","affiliation":[{"name":"Division of Cardiothoracic Surgery, Department of Surgery, Children\u2019s Hospital of Philadelphia, Perelman School of Medicine, University of Pennsylvania , Philadelphia, PA, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Christopher E","family":"Mascio","sequence":"additional","affiliation":[{"name":"Division of Pediatric Cardiothoracic Surgery, Department of Cardiovascular and Thoracic Surgery, West Virginia University School of Medicine , Morgantown, WV, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Thomas L","family":"Spray","sequence":"additional","affiliation":[{"name":"Division of Cardiothoracic Surgery, Department of Surgery, Children\u2019s Hospital of Philadelphia, Perelman School of Medicine, University of Pennsylvania , Philadelphia, PA, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7955-5604","authenticated-orcid":false,"given":"J William","family":"Gaynor","sequence":"additional","affiliation":[{"name":"Division of Cardiothoracic Surgery, Department of Surgery, Children\u2019s Hospital of Philadelphia, Perelman School of Medicine, University of Pennsylvania , Philadelphia, PA, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"286","published-online":{"date-parts":[[2024,4,12]]},"reference":[{"key":"2024042700013528900_ezae164-B1","first-page":"61","article-title":"Pathologic anatomy and interrelationship of hypoplasia of the aortic tract complexes","volume":"1","author":"Lev","year":"1952","journal-title":"Lab Invest"},{"key":"2024042700013528900_ezae164-B2","doi-asserted-by":"crossref","first-page":"1029","DOI":"10.1016\/S0031-3955(16)30727-1","article-title":"The hypoplastic left heart syndrome; an analysis of 101 cases","volume":"5","author":"Noonan","year":"1958","journal-title":"Pediatr Clin North Am"},{"key":"2024042700013528900_ezae164-B3","doi-asserted-by":"crossref","first-page":"624","DOI":"10.1016\/S0022-5223(19)40892-1","article-title":"Hypoplastic left heart syndrome. Experience with an operation to establish functionally normal circulation","volume":"74","author":"Doty","year":"1977","journal-title":"J Thorac Cardiovasc Surg"},{"key":"2024042700013528900_ezae164-B4","doi-asserted-by":"crossref","first-page":"23","DOI":"10.1056\/NEJM198301063080106","article-title":"Physiologic repair of aortic atresia-hypoplastic left heart syndrome","volume":"308","author":"Norwood","year":"1983","journal-title":"N Engl J Med"},{"key":"2024042700013528900_ezae164-B5","doi-asserted-by":"crossref","first-page":"551","DOI":"10.1136\/hrt.69.6.551","article-title":"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","volume":"69","author":"Gibbs","year":"1993","journal-title":"Br Heart J"},{"key":"2024042700013528900_ezae164-B6","doi-asserted-by":"crossref","first-page":"1099","DOI":"10.1161\/hc0902.104709","article-title":"Stenting of the arterial duct and banding of the pulmonary arteries: basis for combined Norwood stage I and II repair in hypoplastic left heart","volume":"105","author":"Akintuerk","year":"2002","journal-title":"Circulation"},{"key":"2024042700013528900_ezae164-B7","doi-asserted-by":"crossref","first-page":"1112","DOI":"10.1016\/j.jtcvs.2015.10.066","article-title":"Hybrid therapy for hypoplastic left heart syndrome: myth, alternative, or standard?","volume":"151","author":"Yerebakan","year":"2016","journal-title":"J Thorac Cardiovasc Surg"},{"key":"2024042700013528900_ezae164-B8","doi-asserted-by":"crossref","first-page":"S123","DOI":"10.1161\/CIRCULATIONAHA.111.084616","article-title":"Hybrid versus Norwood strategies for single-ventricle palliation","volume":"126","author":"Baba","year":"2012","journal-title":"Circulation"},{"key":"2024042700013528900_ezae164-B9","doi-asserted-by":"crossref","first-page":"163","DOI":"10.1016\/j.jtcvs.2005.07.053","article-title":"Single-ventricle palliation for high-risk neonates: the emergence of an alternative hybrid stage I strategy","volume":"131","author":"Bacha","year":"2006","journal-title":"J Thorac Cardiovasc Surg"},{"key":"2024042700013528900_ezae164-B10","doi-asserted-by":"crossref","first-page":"220","DOI":"10.1016\/j.jtcvs.2018.12.117","article-title":"Thirty years and 1663 consecutive Norwood procedures: has survival plateaued?","volume":"158","author":"Mascio","year":"2019","journal-title":"J Thorac Cardiovasc Surg"},{"key":"2024042700013528900_ezae164-B11","doi-asserted-by":"crossref","first-page":"3083","DOI":"10.1002\/sim.3697","article-title":"Balance diagnostics for comparing the distribution of baseline covariates between treatment groups in propensity-score matched samples","volume":"28","author":"Austin","year":"2009","journal-title":"Stat Med"},{"key":"2024042700013528900_ezae164-B12","doi-asserted-by":"crossref","first-page":"399","DOI":"10.1080\/00273171.2011.568786","article-title":"An introduction to propensity score methods for reducing the effects of confounding in observational studies","volume":"46","author":"Austin","year":"2011","journal-title":"Multivariate Behav Res"},{"key":"2024042700013528900_ezae164-B13","doi-asserted-by":"crossref","first-page":"169","DOI":"10.1023\/A:1020363010465","article-title":"Using propensity scores to help design observational studies: application to the tobacco litigation","volume":"2","author":"Rubin","year":"2001","journal-title":"Health Serv Outcomes Res Methodol"},{"key":"2024042700013528900_ezae164-B14","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1214\/09-STS313","article-title":"Matching methods for causal inference: a review and a look forward","volume":"25","author":"Stuart","year":"2010","journal-title":"Stat Sci"},{"key":"2024042700013528900_ezae164-B15","doi-asserted-by":"crossref","first-page":"645","DOI":"10.1136\/heart.89.6.645","article-title":"Stenting of the ductus arteriosus and banding of the pulmonary arteries: basis for 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