Hybrid approach to the comprehensive stage II operation in a subset of single-ventricle variants

Abstract

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.

The Evolution of Therapeutic Strategies: Niche Apportionment for Hybrid Palliation

“…Other groups did not find significant differences in systemic ventricular function [45,46] but indicated that impaired systolic right ventricular strain and strain rate values may be indicative of a subclinical functional decline that becomes relevant during follow-up [46]. After aortic arch reconstruction, patients with initial hybrid palliation also showed higher arterial resistance but better Nassar [38] Pulmonary artery stent graft baffle instead of arch reconstruction at comprehensive stage II DeCampli [39] arterioventricular coupling compared with primary Norwood patients [47]. Bilateral pulmonary artery banding shows a similar diastolic pulmonary runoff than that seen with modified Blalock-Taussig shunts [42].…”

“…DeCampli and colleagues [39] modified the comprehensive stage II procedure by creation of a stented baffle within the pulmonary artery. The baffle connected both pulmonary artery branches while isolating them from the main pulmonary artery-to-aorta pathway, thereby keeping the native main pulmonary artery, aortic, and ductal anatomy.…”

“…The baffle connected both pulmonary artery branches while isolating them from the main pulmonary artery-to-aorta pathway, thereby keeping the native main pulmonary artery, aortic, and ductal anatomy. The underlying rationale was to avoid aortic arch reconstruction in a subset of patients with unobstructed flow through the subaortic outflow track and aortic root [39].…”

Keeping the fundamentals in mind

“…Despite important improvements in surgical outcomes, management of patients with single-ventricle physiology and systemic outflow obstruction remains difficult, and renewed efforts are aimed at achieving improved functional outcomes. The work presented by DeCampli and colleagues 1 in this issue of the Journal represents a new approach to simplify the intervention commonly undertaken as the second-stage palliation in those patients who have previously undergone a hybrid procedure for single-ventricle physiology. As stated by DeCampli and colleagues, 1 ''a substantial decrease in trauma at the second stage could tip the balance in favor of the hybrid approach.''…”

“…As we know 3 decades later, these created a setup for multiple and recurrent interventions, associated with scarring, fibrosis, and unintended effects, which complicated further surgery and intervention. 4 Finally, as DeCampli and colleagues 1 have clearly pointed out, the presence of sufficient antegrade blood flow to perfuse the brachiocephalic vessels is essential, limiting the applicability of this approach among patients with single-ventricle physiology and systemic outflow obstruction.…”