Hybrid procedures in hypoplastic left heart  physiology

Oleksandır  Plyska; Igor  Ditkivsky; Vasiliy  Lazoryshynets

doi:10.28942/acj.v26i2y2024.117

Abstract

Neonatal reconstructive procedures are designed to allow survival without the use of prostaglandins to maintain ductal patency. The hybrid procedure for hypoplastic left heart physiology was developed in response to poor outcomes following the Norwood procedure. This approach combines surgical placement of bilateral branch pulmonary artery (PA) bands, stent implantation in the ductus arteriosus, and catheter-based atrial septostomy (Rashkind procedure), thereby avoiding cardiopulmonary bypass (CPB). Initially, the hybrid procedure was not widely adopted because of suboptimal interim outcomes; however, more recently, it has been used by some centers as an alternative to the Norwood procedure in high-risk patients. In addition, variations of the hybrid procedure have been applied as a bridge to heart transplantation.

Full article

Objective. To present the experience of endovascular procedures in newborns with hypoplastic left heart physiology.

Methods. From 2012 to 2017, 15 patients with hypoplastic left heart physiology underwent hybrid procedures. All patients were newborns (1–9 days of life) in critical condition. The age of patients ranged from 2 to 12 days, with a mean of 9.1 ± 2.4 days. Body weight was 2.24 ± 0.14 kg. Ascending aorta dimensions were <2 mm. In 11 patients, congenital heart disease was detected prenatally; in 4 patients, postnatally. All 15 patients underwent bilateral banding of pulmonary artery branches combined with stenting of the ductus arteriosus. In 2 patients, self-expandable stents were used; in 13, balloon-expandable stents were applied. In 3 patients, the intervention was additionally combined with the Rashkind procedure. Adequacy of bilateral pulmonary artery banding was reflected by maintaining systemic arterial pressure >70–80 mmHg and SaO₂ ≥85–90%.

Results. Four of 15 patients achieved uneventful recovery; 11 died. In-hospital mortality was 73.3%. One patient underwent successful re-stenting of the ductus arteriosus three years later. Fatal postoperative complications included septic complications in 2 patients; stent and aortic isthmus thrombosis with consequent coronary insufficiency in 4; stenosis of stent with occlusion of aortic isthmus in 1; left atrium perforation during Rashkind procedure in 1.