title: Hybrid approach for hypoplastic left heart syndrome: intermediate results after the learning curve.
abstract: BACKGROUND
  Lessons learned during the development of a novel hybrid approach have resulted in a reliable, reproducible alternative treatment for hypoplastic left heart syndrome (HLHS). Herein we report our results using this hybrid approach in a uniform risk cohort.
  
  
  METHODS
  This is a review of prospectively collected data on patients treated for HLHS using a hybrid approach (n = 40) between July 2002 and June 2007. The hybrid approach includes pulmonary artery bands, a ductal stent, and atrial septostomy as a neonate, comprehensive stage 2 procedure resulting in Glenn shunt physiology at six months and Fontan completion at two years.
  
  
  RESULTS
  Forty patients had a hybrid stage 1 with 36 undergoing a comprehensive stage 2 procedure. Fifteen patients have completed the Fontan procedure with 17 pending. Overall survival was 82.5% (33 of 40). The seven deaths included one at stage 1, two between stages 1 and 2, three at stage 2, and one between stages 2 and 3. One patient had successful heart transplantation during the interstage period.
  
  
  CONCLUSIONS
  The hybrid approach can yield acceptable intermediate results that are comparable with a traditional Norwood strategy. Potential advantages of the hybrid approach include the avoidance of circulatory arrest and shifting the major surgical stage to later in life. These data provide the platform for a prospective trial comparing these two surgical options to assess whether there is less cumulative impact with the hybrid approach, thereby improving end organ function, quality, and quantity of life.
authors.affiliation: The Heart Center, Nationwide Children's Hospital, The Ohio State University, Columbus, Ohio, USA. mark.galantowicz@nationwidechildrens.org
authors.forename: Mark
authors.initials: M
authors.lastname: Galantowicz
authors.forename: John P
authors.initials: JP
authors.lastname: Cheatham
authors.forename: Alistair
authors.initials: A
authors.lastname: Phillips
authors.forename: Clifford L
authors.initials: CL
authors.lastname: Cua
authors.forename: Timothy M
authors.initials: TM
authors.lastname: Hoffman
authors.forename: Sharon L
authors.initials: SL
authors.lastname: Hill
authors.forename: Roberta
authors.initials: R
authors.lastname: Rodeman
mesh_terms: D006328:Cardiac Catheterization; D002404:Catheterization; D002423:Cause of Death; D015331:Cohort Studies; D003131:Combined Modality Therapy; D004373:Ductus Arteriosus / Q000601:surgery; D005260:Female; D005500:Follow-Up Studies; D018729:Fontan Procedure; D006346:Heart Septum / Q000601:surgery; D016027:Heart Transplantation; D006801:Humans; D018636:Hypoplastic Left Heart Syndrome / Q000401:mortality / Q000601:surgery*; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D019060:Minimally Invasive Surgical Procedures; D010166:Palliative Care; D011183:Postoperative Complications / Q000401:mortality*; D011651:Pulmonary Artery / Q000601:surgery; D012086:Reoperation; D012189:Retrospective Studies; D015607:Stents; D015996:Survival Rate