title: Combined Surgical and Interventional Approaches for Treating Patients with Congenital Heart Disease.
abstract: OBJECTIVE
  During the last decade the cooperation between surgeons and cardiologists has further expanded by combining surgical and interventional techniques (CCBSI) performed in the operating room, without the use of fluoroscopy. We sought to evaluate the results of our experience with CCBSI.
  
  
  METHODS
  All children with congenital heart disease (CHD) who underwent a CCBSI in the operating room between June 2007 and January 2014 were enrolled.
  
  
  RESULTS
  Sixty-eight patients were included. Median age at CCBSI was five months (range 1-48 months). The three main diagnoses leading to surgery included: (1) tetralogy of Fallot (TOF) (n = 40), (2) muscular ventricular septal defects (VSD) (n = 12), (3) single ventricle with pulmonary artery branch stenosis (n = 4). There were 72 catheter-based procedures associated with surgical maneuvres, including: (1) transatrial balloon dilation (BD) of the pulmonary valve (n = 45), (2) transinfundibular BD of the main pulmonary artery trunk (n = 12), (3) perventricular VSD closure with septal occluder (n = 8), (4) BD of pulmonary artery branches (n = 5), and other less common procedures (n = 2). There were no procedure-related complications and no hospital deaths. Median follow-up time was four years (range 0.95-7.9 years). There was one late death for respiratory distress after transapical balloon dilation of the aortic valve. One patient required BD and stenting of the left pulmonary artery branch 3.6 years after intraoperative BD for residual stenosis.
  
  
  CONCLUSIONS
  The CCBSI represents a safe and effective treatment for selected patients with complex CHD. It will be helpful in minimizing patients' surgical trauma and in shortening or avoiding the use of cardiopulmonary bypass.
authors.affiliation: Pediatric and Congenital Cardiac Surgery Unit, Department of Thoracic, Cardiac and Vascular Sciences, University of Padua, Padua, Italy.
authors.forename: Vladimiro L
authors.initials: VL
authors.lastname: Vida
authors.affiliation: Pediatric and Congenital Cardiac Surgery Unit, Department of Thoracic, Cardiac and Vascular Sciences, University of Padua, Padua, Italy.
authors.forename: Alvise
authors.initials: A
authors.lastname: Guariento
authors.affiliation: Pediatric and Congenital Cardiac Surgery Unit, Department of Thoracic, Cardiac and Vascular Sciences, University of Padua, Padua, Italy.
authors.forename: Fabio
authors.initials: F
authors.lastname: Zucchetta
authors.affiliation: Pediatric and Congenital Cardiac Surgery Unit, Department of Thoracic, Cardiac and Vascular Sciences, University of Padua, Padua, Italy.
authors.forename: Massimo A
authors.initials: MA
authors.lastname: Padalino
authors.affiliation: Pediatric Cardiology Unit, Department of Paediatrics, University of Padua, Padua, Italy.
authors.forename: Ornella
authors.initials: O
authors.lastname: Milanesi
authors.affiliation: Pediatric Cardiology Unit, Department of Paediatrics, University of Padua, Padua, Italy.
authors.forename: Nicola
authors.initials: N
authors.lastname: Maschietto
authors.affiliation: Pediatric and Congenital Cardiac Surgery Unit, Department of Thoracic, Cardiac and Vascular Sciences, University of Padua, Padua, Italy.
authors.forename: Giovanni
authors.initials: G
authors.lastname: Stellin
mesh_terms: D006328:Cardiac Catheterization / Q000379:methods; D006348:Cardiac Surgical Procedures / Q000379:methods*; D002315:Cardiopulmonary Bypass; D002675:Child, Preschool; D003131:Combined Modality Therapy; D004106:Dilatation / Q000379:methods; D029968:Escherichia coli Proteins; D005260:Female; D006330:Heart Defects, Congenital / Q000628:therapy*; D006801:Humans; D007223:Infant; D008297:Male; D061646:Operative Time; D011651:Pulmonary Artery; D011664:Pulmonary Valve; D055989:Septal Occluder Device; D015607:Stents; D013762:Tetrahydrofolate Dehydrogenase; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D029968:Escherichia coli Proteins; C479919:FolM protein, E coli; D013762:Tetrahydrofolate Dehydrogenase