Korean Circ J.  2010 Mar;40(3):103-111. 10.4070/kcj.2010.40.3.103.

Hybrid Palliation for Neonates With Hypoplastic Left Heart Syndrome: Current Strategies and Outcomes

• Honjo O
• Caldarone

• KMID: 2094068
• DOI: http://doi.org/10.4070/kcj.2010.40.3.103

Abstract

In the last decade the hybrid procedure has emerged as an alternative stage I palliation in neonates with hypoplastic left heart syndrome (HLHS). This review discusses the historical aspect, surgical and interventional techniques, current outcomes and future direction of this procedure. Hybrid palliation yields equivalent but not superior stage I palliation survival and comparable 1-year survival to conventional Norwood palliation, comparable prestage II hemodynamics and pulmonary artery growth, and preserved ventricular function in stage II palliation. Hybrid palliation utilizes significantly less resource and shortens postoperative recovery. In comprehensive stage II palliation the impact of pulmonary artery reconstruction on subsequent pulmonary artery growth has not been determined and should be further investigated. A prospective, randomized trial is warranted to compare these two surgical strategies for neonates with hypoplastic left heart syndrome.

Keyword

Hypoplastic left heart syndrome; Stents; Heart defects; Congenital

MeSH Terms

Chimera
Heart
Hemodynamics
Humans
Hypoplastic Left Heart Syndrome
Infant, Newborn
Pulmonary Artery
Stents
Ventricular Function

Figure

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  Fig. 1 Angiographic sequence of stent deployment in hybrid stage I palliation. A: the lateral view showing the sheath and guide wire inserted via the main PA through the arterial duct. B: pre-stenting angiogram showing unobstructed aortic isthmus and reasonable retrograde filling of the aortic arch. C: stent deployment. D: post-stenting angiogram showing reasonable retrograde aortic arch blood flow.

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  Fig. 2 A: anterior-posterior view showing post-hybrid configuration. The asterisks represent the site of branch PA bands. B: the black asterisk showing a guiding vascular clip placed on the proximal edge of the left PA band. PA: pulmonary artery.

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  Fig. 3 Modified aortic arch reconstruction in comprehensive stage II palliation using a retained stented duct (reproduced with publisher's permission). A: main PA division. B and C: resection of the branch PAs as a single button. The single arrow showing the aortic isthmus. D: division of apposition between the ascending aorta and the stented duct. E: reconstruction of the aortic arch by sewing the lateral edges of aortic arch and stented duct. F: reconstructed aortic arch. PA: pulmonary artery.

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  Fig. 4 The lateral view of aortic arch reconstruction using a retained stented duct. The asterisk showing the left branch PA. PA: pulmonary artery.

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  Fig. 5 Hemodynamics and oxygen transport parameters after hybrid (n=6) or Norwood procedures (n=13). SAP: systolic arterial pressure, DAP: diastolic blood pressure, MAP: mean arterial pressure, tPVR: total pulmonary vascular resistance, SVR: systemic vascular resistance, Qp/Qs: pulmonary-to-systemic flow ratio, CO: cardiac output, Qp: pulmonary blood flow, Qs: systemic blood flow, DO2: oxygen delivery; VO2: oxygen consumption, ERO2: oxygen extraction ratio (reproduced with publisher's permission).

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  Fig. 6 Clinical outcomes of the patients undergoing hybrid (n=19) or Norwood (n=39) single ventricle palliation. BCPS: bidirectional cavopulmonary shunt.

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  Fig. 7 Kaplan-Meier survival analysis comparing the hybrid and Norwood groups. There was no difference in 1-year survival (hybrid, 73% vs. Norwood, 69%, p=0.83).

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