title: Hybrid approach to the comprehensive stage II operation in a subset of single-ventricle variants.
abstract: OBJECTIVE
  The objective of a hybrid approach to staged palliation of single-ventricle anomalies is designed to minimize the trauma of the first stage. However, the second stage is a complex procedure that may negate the advantages of the first stage. We sought to devise a "hybrid" approach to the second stage when aortic outflow is expected to remain unobstructed.
  
  
  METHODS
  The procedure involves a simple incision into the main pulmonary artery, dilation/stenting of the ductal continuation, formation of a stented baffle between the branch pulmonary arteries' orifices, and a bidirectional Glenn connection. It avoids dissection of the distal arch and ductal continuation and obviates the need for a Damus-Kaye-Stansel connection. We carried out this procedure in 2 patients, one with unbalanced atrioventricular canal and the other with mitral atresia.
  
  
  RESULTS
  Both patients underwent an uncomplicated operative procedure. Both patients were successfully weaned from the ventilator, with no clinically evident neurologic injury. The first patient died of complications related to thrombosis of the left pulmonary artery before initiation of anticoagulation. The second patient is alive and well 1 year postoperation with no obstruction to either systemic or pulmonary flow and no baffle leak and good right ventricle function.
  
  
  CONCLUSIONS
  This hybrid comprehensive stage II operation appears feasible and technically simpler than the conventional comprehensive stage II procedure. It is applicable to a subset of single-ventricle cases in which aortic outflow is anticipated to remain unobstructed. We recommend early postoperative anticoagulation to avoid early left pulmonary artery thrombosis.
authors.affiliation: The Heart Center at Arnold Palmer Hospital for Children, Orlando, Fla; and College of Medicine, University of Central Florida, Orlando, Fla. Electronic address: William.decampli@orlandohealth.com.
authors.forename: William M
authors.initials: WM
authors.lastname: DeCampli
authors.affiliation: The Heart Center at Arnold Palmer Hospital for Children, Orlando, Fla; and College of Medicine, University of Central Florida, Orlando, Fla.
authors.forename: Craig E
authors.initials: CE
authors.lastname: Fleishman
authors.affiliation: The Heart Center at Arnold Palmer Hospital for Children, Orlando, Fla; and College of Medicine, University of Central Florida, Orlando, Fla.
authors.forename: David G
authors.initials: DG
authors.lastname: Nykanen
mesh_terms: D000925:Anticoagulants / Q000627:therapeutic use; D001157:Arterial Occlusive Diseases / Q000209:etiology; D006328:Cardiac Catheterization / Q000009:adverse effects / Q000295:instrumentation; D017809:Fatal Outcome; D018729:Fontan Procedure / Q000009:adverse effects / Q000379:methods*; D006352:Heart Ventricles / Q000002:abnormalities / Q000503:physiopathology / Q000601:surgery*; D006801:Humans; D018636:Hypoplastic Left Heart Syndrome / Q000175:diagnosis / Q000503:physiopathology / Q000601:surgery*; D007231:Infant, Newborn; D010166:Palliative Care; D011651:Pulmonary Artery / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000601:surgery*; D011859:Radiography; D015607:Stents; D013927:Thrombosis / Q000209:etiology; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D000925:Anticoagulants