title: Alternative hybrid and staged interventional treatment of congenital heart defects in critically ill children with complex and non-cardiac problems.
abstract: BACKGROUND
  An individually designed strategy of comprehensive alternative hybrid and staged interventional treatment (AHASIT) can be a reasonable alternative to conventional treatment of congenital heart defects, reduce the risk of cardiac surgery or interventions performed separately, and give an additional chance for critically ill children.
  
  
  OBJECTIVE
  To present our experience and the results of AHASIT of severely ill or borderline children referred for surgery with the diagnosis of congenital heart defects.
  
  
  METHODS
  A group of 22 patients with complex cardiac and non-cardiac pathologies was retrospectively selected and analyzed. An individual preoperative severity scale was established for AHASIT patients, with one point for each of the following preoperative complications: prematurity, low body weight, cyanosis, intolerance to drug therapy, failed interventional treatment prior to admission, mechanical ventilation prior to the procedure, chronic respiratory failure and non-cardiac, mainly congenital malformations (congenital diaphragmatic hernia, lower extremity agenesia, duodenal atresia) and acquired problems (newborn edema, necrotic enterocolitis, intracranial hemorrhage, liver and renal failure, anemia and thrombocytopenia, infections or colonization with drug-resistant pathogens).
  
  
  RESULTS
  The analysis of the postoperative course showed that the patients with 5 AHASIT points or more had a more complicated postoperative course than the patients with 1 to 4 AHASIT points.
  
  
  CONCLUSIONS
  The AHASIT of pediatric congenital heart defects with complex and non-cardiac problems appeared to be an attractive option for selected severely ill patients. The strategy was found to be effective in selected neonates suffering from complex and accompanying non-cardiac pathologies, with positive final results of both cardiological intervention and planned surgery.
authors.affiliation: Chair of Physiotherapy, Gdansk University of Physical Education and Sport, Gdansk, Poland ; Department of Pediatric Cardiac Surgery, Mikolaj Kopernik Hospital, Gdansk, Poland.
authors.forename: Ireneusz
authors.initials: I
authors.lastname: Haponiuk
authors.affiliation: Department of Pediatric Cardiac Surgery, Mikolaj Kopernik Hospital, Gdansk, Poland.
authors.forename: Maciej
authors.initials: M
authors.lastname: Chojnicki
authors.affiliation: Department of Pediatric Cardiac Surgery, Mikolaj Kopernik Hospital, Gdansk, Poland.
authors.forename: Radosław
authors.initials: R
authors.lastname: Jaworski
authors.affiliation: Department of Pediatric Cardiac Surgery, Mikolaj Kopernik Hospital, Gdansk, Poland.
authors.forename: Mariusz
authors.initials: M
authors.lastname: Steffens
authors.affiliation: Department of Pediatric Cardiac Surgery, Mikolaj Kopernik Hospital, Gdansk, Poland.
authors.forename: Aneta
authors.initials: A
authors.lastname: Szofer-Sendrowska
authors.affiliation: Department of Pediatric Cardiac Surgery, Mikolaj Kopernik Hospital, Gdansk, Poland.
authors.forename: Konrad
authors.initials: K
authors.lastname: Paczkowski
authors.affiliation: Department of Pediatric Cardiac Surgery, Mikolaj Kopernik Hospital, Gdansk, Poland.
authors.forename: Ewelina
authors.initials: E
authors.lastname: Kwaśniak
authors.affiliation: Department of Oncological and Plastic Surgery, Medical University of Gdansk, Gdansk, Poland.
authors.forename: Jacek
authors.initials: J
authors.lastname: Zieliński
authors.affiliation: Department of Rehabilitation, Medical University of Gdansk, Gdansk, Poland.
authors.forename: Katarzyna
authors.initials: K
authors.lastname: Gierat-Haponiuk
authors.affiliation: Department of Obstetrics, Medical University of Gdansk, Gdansk, Poland.
authors.forename: Katarzyna
authors.initials: K
authors.lastname: Leszczyńska
keywords: cardiac surgery; hybrid technique; interventional cardiology; newborn; transcatheter