Hybrid procedure as an alternative to surgical palliation of high-risk infants with hypoplastic left heart syndrome and its variants.
OBJECTIVE
Despite improvements in the surgical management of neonates with the hypoplastic left heart syndrome and its variants, there is a subset of children who have a high predicted mortality. We have analyzed and report our results with the hybrid approach in the management of these high-risk patients.


METHODS
Children identified by our selection criteria underwent the initial hybrid procedure performed in the catheterization laboratory. This consists of surgical banding of the branch pulmonary arteries and stenting of the arterial duct. This was followed 3 to 6 months later by the combined stage I and II Norwood operation or biventricular repair.


RESULTS
Between December 2005 and May 2008, 21 neonates were selected for the hybrid procedure, of whom 16 had typical hypoplastic left heart syndrome. The remaining 5 neonates had severe aortic stenosis with borderline left ventricular dimensions or poor left ventricular function at presentation. Four neonates had a virtually intact interatrial septum and required urgent intervention immediately after birth. There were 6 deaths as inpatients or up to 30 days after the procedure and 1 interstage death before the combined stage I and II operation. Thus far, of 12 babies who have undergone the next operation, 9 have had the combined stage I and II operation and 3 have had a biventricular repair. Two of these 12 babies have died after the combined stage I and II operation.


CONCLUSIONS
A hybrid approach may be a valuable alternative to the management of high-risk neonates with hypoplastic left heart syndrome and its variants.
Venugopal
Prem S
PS
Evelina Children's Hospital, Department of Congenital Heart Disease, Guy's & St Thomas' NHS Foundation Trust, London, United Kingdom.
Luna
Karyn P
KP
Anderson
David R
DR
Austin
Conal B
CB
Rosenthal
Eric
E
Krasemann
Thomas
T
Qureshi
Shakeel A
SA
D001024:Aortic Valve Stenosis / Q000503:physiopathology / Q000628:therapy; D006328:Cardiac Catheterization / Q000009:adverse effects / Q000295:instrumentation / Q000401:mortality; D006348:Cardiac Surgical Procedures / Q000009:adverse effects / Q000401:mortality; D006439:Hemodynamics; D017052:Hospital Mortality; D006801:Humans; D018636:Hypoplastic Left Heart Syndrome / Q000401:mortality / Q000503:physiopathology / Q000601:surgery / Q000628:therapy*; D007231:Infant, Newborn; D010166:Palliative Care; D018570:Risk Assessment; D012307:Risk Factors; D015607:Stents; D013997:Time Factors; D016896:Treatment Outcome; D016277:Ventricular Function, Left