title: Hybrid approach for pulmonary atresia with intact ventricular septum: early single center results and comparison to the standard surgical approach.
abstract: OBJECTIVE
  To examine acute and mid-term patient outcomes following the hybrid approach to pulmonary atresia with intact ventricular septum (PA-IVS) compared with the standard surgical approach.
  
  
  BACKGROUND
  A subset of PA-IVS patients with the prospect of biventricular circulation typically undergo surgical or transcatheter right ventricular (RV) outflow tract opening. A recently described hybrid procedure, involving perventricular pulmonary valve perforation, was shown to be safe and effective in single-center series.
  
  
  METHODS
  A single-center retrospective review of all patient with PA-IVS who underwent either surgical or hybrid RV decompression between January 2002 and December 2011 was completed and acute and mid-term patient outcomes were compared between the surgical and hybrid cohorts. Additionally, a systematic literature review was completed to compare a transcatheter cohort to the hybrid cohort.
  
  
  RESULTS
  Seven patients with PA-IVS underwent a hybrid procedure; the procedure was technically successful in all attempts, and none required CPB. No patients required surgical re-intervention prior to hospital discharge, and none died during the study period. Surgical RV decompression was performed in 17 patients with a median CPB time of 80 min. Patient outcomes were nearly identical between cohorts. By systematic review, the transcatheter approach has a procedural success of 75-95% but up to 75% of patients require operation in the neonatal period.
  
  
  CONCLUSIONS
  The hybrid approach is a safe and feasible alternative to the standard surgical and transcatheter approaches to PA-IVS. Acute and mid-term patient outcomes are comparable with those treated with a standard surgical approach and neonatal CPB is completely avoided.
authors.affiliation: Division of Pediatric Cardiology, Department of Pediatrics, University of Michigan, Ann Arbor, Michigan.
authors.forename: Jeffrey D
authors.initials: JD
authors.lastname: Zampi
authors.forename: Jennifer C
authors.initials: JC
authors.lastname: Hirsch-Romano
authors.forename: Bryan H
authors.initials: BH
authors.lastname: Goldstein
authors.forename: Justin A
authors.initials: JA
authors.lastname: Shaya
authors.forename: Aimee K
authors.initials: AK
authors.lastname: Armstrong
mesh_terms: D006328:Cardiac Catheterization / Q000009:adverse effects; D006348:Cardiac Surgical Procedures / Q000009:adverse effects; D002315:Cardiopulmonary Bypass; D019299:Decompression, Surgical / Q000009:adverse effects; D005260:Female; D006330:Heart Defects, Congenital / Q000175:diagnosis / Q000503:physiopathology / Q000601:surgery / Q000628:therapy*; D006801:Humans; D007231:Infant, Newborn; D008297:Male; D008824:Michigan; D018633:Pulmonary Atresia / Q000175:diagnosis / Q000503:physiopathology / Q000601:surgery / Q000628:therapy*; D012189:Retrospective Studies; D013997:Time Factors; D016896:Treatment Outcome
keywords: congenital heart defect; hybrid cardiac surgery; patient outcome assessment; pediatric interventions; perventricular procedure