The Retrograde Aortic Arch in the Hybrid Approach to Hypoplastic Left Heart Syndrome

Hybrid Procedures in Congenital Heart Disease

“…Egan and colleagues 14 reported that 29% of patients developed RAAO at some stage following hybrid stage I palliation. The development of RAAO carries a guarded prognosis, with Stoica and colleagues 19 reporting only a 44% survival to Fontan completion out of 16 patients who required surgical or transcatheter interventions for RAAO. Any concern about the development of a significant RAAO should lead to hospital admission, as well as transcatheter evaluation and potential therapy, and this should occur before it manifests through deterioration of right ventricular (RV) function as well as increasing tricuspid regurgitation, which are ominous signs in these patients.…”

“…1), should be seen as a contraindication to hybrid palliation. 14,19 Placing a stent across the PDA in a patient with a preexisting RAA obstruction can have catastrophic consequences, 5,19 and therefore a more conventional Norwood-type palliation is favored in these patients.…”

“…John Cheatham and Mark Galantowicz from Nationwide Children's Hospital in Columbus have reported extensively on the hybrid approach to palliation of patients with HLHS. 5,[13][14][15][16][17][18][19] Initial attempts were made at using an all-catheterbased approach, combining percutaneous ductal stent placement and balloon atrial septostomy with placement of a pulmonary artery flow restrictor (St Jude Medical, St Paul, MN). However, because of the stiffness of the delivery cable and the need for long sheaths, this approach was hemodynamically poorly tolerated and therefore abandoned.…”

The hybrid approach for palliation of hypoplastic left heart syndrome: Intermediate results of a single-center experience

“…35 Its incidence ranges from 8% to 30%. Some centers have managed this problem by stenting the stenotic isthmus, 36 thus rendering reconstructive arch surgery even more challenging, or by creating a prophylactic reverse Blalock-Taussig shunt, 37 while others consider evidence of restricted flow into the retrograde transverse aorta from the ductus arteriosus an exclusion criterion for the hybrid procedure. 15 Nevertheless, it is highly desirable to avoid a hybrid procedure in patients with obstruction to retrograde arch blood flow, which leads to poorer results and significantly increased mortality.…”

Use of the Hybrid Operating Room in Cardiovascular Medicine

“…However, initial enthusiasm for this procedure has tapered as a result of several problems. The hybrid procedure has lower brain oxygen delivery compared with the traditional Norwood procedure, 53 occurrence of retrograde coarctation, 54 and inferior outcomes than that of the traditional Norwood procedure. 55 Other congenital cardiac procedures that use a hybrid approach are repair of pulmonary venous baffle obstruction after atrial switch operation for transposition of the great arteries, 56 perventricular closure of ventricular septal defect using occluder device, 57 and pulmonary artery stenting for stenosis or tortuous pulmonary artery during repair.…”