title: Hybrid procedures can reduce the risk of congenital cardiovascular surgery.
abstract: BACKGROUND
  Minimally invasive operations and percutaneous interventions are well-accepted options in the treatment of congenital heart defects. However, percutaneous interventions may be associated with an increased risk due to limited vascular access or a very tortuous catheter course. In these cases, combining operative and interventional approaches with direct puncture of the heart or the great vessels may facilitate implantation of even large devices. Furthermore, in some situations, cardiopulmonary bypass or circulatory arrest can be omitted when doing a hybrid procedure.
  
  
  METHODS
  Between January 2000 and April 2007 17 patients were operated in a hybrid fashion. Age ranged from 14 days to 45 years. Operative procedures consisted of implantation of an atrial septal defect occluder via direct puncture of the right atrium (n=4), closure of a ventricular septal defect via direct puncture of the right ventricle (n=1), implantation of isthmus stents via the ascending aorta (n=5), redilation of an isthmus stent (n=1), redilation of a ductal stent (n=1), angioplasty of a pulmonary artery stenosis (n=1), interventional occlusion of an intrahepatic porto-caval shunt (n=1), stent implantation into the right pulmonary artery (n=1) and into the right ventricular outflow tract (n=1) under direct vision as well as atrioseptoplasty combined with a bilateral pulmonary artery banding in one newborn with a single ventricle and very low birth weight (n=1).
  
  
  RESULTS
  The planned intervention could be performed in all cases under the assistance of intraoperative fluoroscopy, transesophageal or epicardial echocardiography, or under direct vision. In all cases, the primary hemodynamic objectives were achieved.
  
  
  CONCLUSIONS
  In selected patients, the combination of a surgical procedure and a percutaneous intervention may help to reduce both operative and interventional risks. This concept may enable new treatment options, especially in patients with complex congenital heart defects or complex vascular situations.
authors.affiliation: Department of Cardiac Surgery, University of Munich, Munich, Germany. Christoph.Schmitz@med.uni-muenchen.de
authors.forename: Christoph
authors.initials: C
authors.lastname: Schmitz
authors.forename: Bahman
authors.initials: B
authors.lastname: Esmailzadeh
authors.forename: Ulrike
authors.initials: U
authors.lastname: Herberg
authors.forename: Nora
authors.initials: N
authors.lastname: Lang
authors.forename: Ralf
authors.initials: R
authors.lastname: Sodian
authors.forename: Rainer
authors.initials: R
authors.lastname: Kozlik-Feldmann
authors.forename: Armin
authors.initials: A
authors.lastname: Welz
authors.forename: Johannes
authors.initials: J
authors.lastname: Breuer
mesh_terms: D017548:Echocardiography, Transesophageal; D005471:Fluoroscopy; D006330:Heart Defects, Congenital / Q000000981:diagnostic imaging / Q000601:surgery*; D006344:Heart Septal Defects, Atrial / Q000000981:diagnostic imaging / Q000601:surgery; D006345:Heart Septal Defects, Ventricular / Q000601:surgery; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008875:Middle Aged; D019060:Minimally Invasive Surgical Procedures / Q000379:methods*; D019736:Prostheses and Implants; D015641:Radiography, Interventional; D015607:Stents; D018084:Ultrasonography, Interventional / Q000379:methods; D055815:Young Adult