Hybrid procedure as an alternative to surgical palliation of high-risk infants with hypoplastic left heart syndrome and its variants

Venugopal, Prem; Luna, Karyn P.; Anderson, David; Austin, Conal; Rosenthal, Éric; Krasemann, Thomas; Qureshi, Shakeel A.

doi:10.1016/j.jtcvs.2009.11.037

Cited by 75 publications

(81 citation statements)

References 22 publications

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“…Alternative treatment strategies such as ductal stenting for SV patients with restricted pulmonary blood flow or hybrid palliation (ductal stenting, bilateral branch pulmonary artery banding, and atrial septectomy) in patients with excessive pulmonary blood flow and systemic outflow tract obstruction, have been proposed by some groups with promising results and might prove to be advantageous in high-risk patients including those with low weight [19][20][21][22].…”

Section: Commentmentioning

confidence: 99%

Single Ventricle Palliation in Low Weight Patients Is Associated With Worse Early And Midterm Outcomes

Alsoufi

McCracken

Ehrlich

et al. 2015

The Annals of Thoracic Surgery

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Section: Commentmentioning

confidence: 99%

Single Ventricle Palliation in Low Weight Patients Is Associated With Worse Early And Midterm Outcomes

Alsoufi

McCracken

Ehrlich

et al. 2015

The Annals of Thoracic Surgery

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“…By avoiding cardiopulmonary bypass and cardiac or total circulatory arrest, the hybrid palliation procedure gained popularity initially as an option for HLHS patients for whom the surgical Norwood operation was considered high risk. 2,3 However, encouraged by improved techniques and accumulated experience to overcome the early "learning curve," some institutions have adopted the hybrid approach as the definitive strategy for stage 1 HLHS palliation. 4,5 Although the procedures share common objectives, the circulatory arrangement after hybrid palliation is distinctly different from either of the 2 surgical Norwood procedures.…”

mentioning

confidence: 99%

Use of Mathematical Modeling to Compare and Predict Hemodynamic Effects Between Hybrid and Surgical Norwood Palliations for Hypoplastic Left Heart Syndrome

et al. 2011

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Background-Combining bilateral pulmonary artery banding with arterial duct stenting, the hybrid approach achieves stage 1 palliation for hypoplastic left heart syndrome with different flow characteristics than those after the surgical Norwood procedures. Accordingly, we used computational modeling to assess some of these differences, including influence on systemic and cerebral oxygen deliveries. Methods and Results-A 3-dimensional computational model of hybrid palliation was developed by the finite volume method, along with models of the Norwood operation with a modified Blalock-Tausig or right ventricle-to-pulmonary artery shunt. Hybrid circulation was modeled with a 7-mm ductal stent and bilateral pulmonary artery banding to a 2-mm diameter. A 3.5-mm conduit was used in the Blalock-Tausig shunt model, whereas a 5-mm conduit was used in the right ventricle-to-pulmonary artery shunt model. Coupled to all the models was an identical hydraulic network that described the entire circulatory system based on pre-stage 2 hemodynamics. This clinically validated multiscale approach predicts flow dynamics, as well as global cardiac output, mixed venous oxygen saturation, and systemic and cerebral oxygen delivery. Compared with either of the Norwood models, the hybrid palliation had higher pulmonary-to-systemic flow ratio and lower cardiac output. Total systemic oxygen delivery was markedly reduced in the hybrid palliation (Blalock-Tausig shunt 591, right ventricle-to-pulmonary artery shunt 640, and hybrid 475 mL ⅐ min Ϫ1 ⅐ m Ϫ2 ). Cerebral oxygen delivery was similarly lower in the hybrid palliation. Conclusions-These

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“…The first case describes hybrid stenting of the arterial duct in a small infant weighing 1 kg where a surgical shunt would have been extremely challenging. Hybrid approach to ductal stenting has been reported predominantly in conjunction with early palliation of hypoplastic left heart syndrome [8], however, we adapted the procedure to this small infant with TGA in an attempt to increase volume loading to the left ventricle prior to the arterial switch operation. This strategy has been described before in the setting of TGA, however in larger infants and via a femoral approach [9].…”

Section: Discussionmentioning

confidence: 99%

Variable approaches to arterial ductal stenting in infants with complex congenital heart disease

Kenny

Berman

Zahn

et al. 2012

Cathet Cardio Intervent

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Stenting of the arterial duct to maintain postnatal communication between the pulmonary and systemic arterial circulations in infants with complex congenital heart disease is an acceptable alternative to a surgically created systemic to pulmonary artery shunt. The procedure, however, can be demanding given the variable anatomy of the patent ductus arteriosus. We report a series of cases of ductal stenting via a range of varying approaches in neonates with complex congenital heart disease, and display the variety of situations in which these approaches may be used.

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Hybrid procedure as an alternative to surgical palliation of high-risk infants with hypoplastic left heart syndrome and its variants

Abstract: A hybrid approach may be a valuable alternative to the management of high-risk neonates with hypoplastic left heart syndrome and its variants.

Cited by 75 publications

References 22 publications

Single Ventricle Palliation in Low Weight Patients Is Associated With Worse Early And Midterm Outcomes

Single Ventricle Palliation in Low Weight Patients Is Associated With Worse Early And Midterm Outcomes

Use of Mathematical Modeling to Compare and Predict Hemodynamic Effects Between Hybrid and Surgical Norwood Palliations for Hypoplastic Left Heart Syndrome

Variable approaches to arterial ductal stenting in infants with complex congenital heart disease

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