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Year : 2006  |  Volume : 7  |  Issue : 3  |  Page : 105-110

The hybrid stage 1 operation in hypoplastic left heart syndrome: A new alternative

Associate Professor of Surgery, Harvard Medical School, Senior Associate in Cardiac Surgery, Children's Hospital, Boston, MA, USA

Correspondence Address:
Emile Bacha
Children's Hospital Boston, 300 Longwood Ave. Bader 273, Boston, MA 02115
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Source of Support: None, Conflict of Interest: None

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Hospital survival after the Norwood stage I palliation for hypoplastic left heart syndrome (HLHS) or related anomalies has remarkably improved over the last decade. However, results remain suboptimal. In recent years, hybrid techniques (interventional cardiologists and surgeons working together) have been developed and refined for problems (such as multiple muscular ventricular septal defects) that had no satisfactory solutions with either discipline. The hybrid stage I is a less invasive hybrid approach that allows for a non-pump 1st stage palliation, followed by a comprehensive second stage. The hybrid stage I is typically performed in a hybrid room. Via a median sternotomy, both branch pulmonary arteries (PA) are banded and a ductal stent is delivered via a main PA puncture and positioned under fluoroscopic guidance. Despite the learning curve, hospital survival has been > 80%. The second stage operation consist of aortic arch reconstruction, atrial septectomy and cavopulmonary shunt. Several patients have undergone the last palliative step in the form of a Fontan procedure. The most acute problem after the hybrid stage I has been the development of a so-called retrograde coarctation from ductal tissue in patients with aortic atresia. In conclusion, primary experience with this new off-pump palliation has been satisfactory. This approach can be employed in selected patients.

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