title: Long-term results of biventricular repair after initial Giessen hybrid approach for hypoplastic left heart variants.
abstract: OBJECTIVE
  This article presents the long-term results of our patients with a diagnosis of hypoplastic left heart syndrome (HLHS), hypoplastic left heart complex (HLHC), and variants who received a biventricular repair following hybrid stage I with ductal stenting and bilateral pulmonary artery banding.
  
  
  METHODS
  Between June 1998 and June 2013, a total of 154 patients with hypoplastic left heart structures underwent a hybrid stage I procedure. Forty patients were definitely treated by creating a biventricular circulation. Median age and body weight of patients before hybrid stage I were 8.5 days (2-40) and 3.0 kg (1.6-3.8), respectively. The diagnoses were HLHS with mitral and aortic stenosis (n = 7), HLHC (n = 15), HLHC with interrupted aortic arch (n = 9), critical aortic stenosis with hypoplastic aortic arch (n = 4), imbalanced atrioventricular septal defect with hypoplastic aortic arch (n = 2), double-outlet right ventricle with hypoplastic aortic arch (n = 2), and d-transposition of the great arteries with interrupted aortic arch (n = 1). Median age at the time of biventricular correction was 6.7 months (1.6-13.8). The patients were treated with direct biventricular correction, including repair of intracardiac defects (n = 32), Norwood/Rastelli or Yasui (n = 4), arterial switch (n = 2), Rastelli (n = 1), and Ross-Konno (n = 1) operations with ascending aortic/aortic arch reconstruction.
  
  
  RESULTS
  All patients survived hybrid stage I. Median survival after biventricular correction is 7.9 years (0.9-14.9). Overall mortality was 10% (4 patients) at 4 weeks, 5 weeks, 6 weeks, and 4 months after biventricular correction, respectively. One patient had to be switched to univentricular circulation and another patient underwent orthotopic heart transplantation 3 and 4 months after biventricular correction, respectively.
  
  
  CONCLUSIONS
  The Giessen hybrid approach is an alternative to the conventional strategy to treat neonates with HLHS, HLHC, and variants. Biventricular repair after hybrid stage I is feasible and can be performed with satisfactory long-term survival.
authors.affiliation: Pediatric Heart Center Giessen, Justus-Liebig University, Giessen, Germany.
authors.forename: Can
authors.initials: C
authors.lastname: Yerebakan
authors.affiliation: Pediatric Heart Center Giessen, Justus-Liebig University, Giessen, Germany.
authors.forename: Josephine
authors.initials: J
authors.lastname: Murray
authors.affiliation: Pediatric Heart Center Giessen, Justus-Liebig University, Giessen, Germany.
authors.forename: Klaus
authors.initials: K
authors.lastname: Valeske
authors.affiliation: Pediatric Heart Center Giessen, Justus-Liebig University, Giessen, Germany.
authors.forename: Josef
authors.initials: J
authors.lastname: Thul
authors.affiliation: Pediatric Heart Center Giessen, Justus-Liebig University, Giessen, Germany.
authors.forename: Hatem
authors.initials: H
authors.lastname: Elmontaser
authors.affiliation: Pediatric Heart Center Giessen, Justus-Liebig University, Giessen, Germany.
authors.forename: Matthias
authors.initials: M
authors.lastname: Mueller
authors.affiliation: Pediatric Heart Center Giessen, Justus-Liebig University, Giessen, Germany.
authors.forename: Valesco
authors.initials: V
authors.lastname: Mann
authors.affiliation: Pediatric Heart Center Giessen, Justus-Liebig University, Giessen, Germany.
authors.forename: Stefan
authors.initials: S
authors.lastname: Ostermayer
authors.affiliation: Pediatric Heart Center Giessen, Justus-Liebig University, Giessen, Germany.
authors.forename: Heiner
authors.initials: H
authors.lastname: Latus
authors.affiliation: Pediatric Heart Center Giessen, Justus-Liebig University, Giessen, Germany.
authors.forename: Christian
authors.initials: C
authors.lastname: Apitz
authors.affiliation: Pediatric Heart Center Giessen, Justus-Liebig University, Giessen, Germany.
authors.forename: Dietmar
authors.initials: D
authors.lastname: Schranz
authors.affiliation: Pediatric Heart Center Giessen, Justus-Liebig University, Giessen, Germany. Electronic address: can.yerebakan@chiru.med.uni-giessen.de.
authors.forename: Hakan
authors.initials: H
authors.lastname: Akintuerk
mesh_terms: D006328:Cardiac Catheterization / Q000009:adverse effects / Q000295:instrumentation / Q000401:mortality; D005240:Feasibility Studies; D006352:Heart Ventricles / Q000002:abnormalities / Q000254:growth & development / Q000601:surgery*; D006801:Humans; D018636:Hypoplastic Left Heart Syndrome / Q000175:diagnosis / Q000401:mortality / Q000503:physiopathology / Q000601:surgery*; D007223:Infant; D007231:Infant, Newborn; D053208:Kaplan-Meier Estimate; D058327:Norwood Procedures / Q000009:adverse effects / Q000401:mortality; D010166:Palliative Care; D011651:Pulmonary Artery / Q000503:physiopathology / Q000601:surgery*; D012189:Retrospective Studies; D012307:Risk Factors; D015607:Stents; D013997:Time Factors; D016896:Treatment Outcome; D016277:Ventricular Function, Left