Hybrid Approach: The Columbus Way

  • John P. CheathamEmail author


The neurodevelopmental outcomes after surgical repair of hypoplastic left heart syndrome (HLHS) are the worst of any congenital heart disease (CHD). In addition, the mortality for the conventional stage I surgical approach, the Norwood/Sano procedure, remains high in many institutions across the globe. Although our institution mortality was acceptably low, we wondered whether there could be a more “gentle” approach to stage I palliation that might lead to both lower mortality/morbidity risks and perhaps to improve neurodevelopmental outcomes. Our strategy was to perform an initial hybrid approach using simple surgical and transcatheter techniques of cardiopulmonary bypass, followed by a more robust comprehensive stage II repair at 4–6 months, followed by a transcatheter Fontan completion.


Patent Ductus Arteriosus Hypoplastic Left Heart Syndrome Left Pulmonary Artery Neurodevelopmental Outcome Balloon Atrial Septostomy 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.


  1. 1.
    Galantowicz M, Cheatham JP, Phillips A, Cua CL, Hoffman TM, Hill SL, et al. Hybrid approach for hypoplastic left heart syndrome: intermediate results after the learning curve. Ann Thorac Surg. 2008;85(6):2063–70; discussion 2070–1.CrossRefPubMedGoogle Scholar
  2. 2.
    Akinturk H, Michel-Behnke I, Valeske K, Mueller M, Thul J, Bauer J, et al. Hybrid transcatheter-surgical palliation: basis for univentricular or biventricular repair: the Giessen experience. Pediatr Cardiol. 2007;28(2):79–87.CrossRefPubMedGoogle Scholar
  3. 3.
    Schranz D, Bauer A, Reich B, Steinbrenner B, Recla S, Schmidt D, et al. Fifteen-year single center experience with the “Giessen Hybrid” approach for hypoplastic left heart and variants: current strategies and outcomes. Pediatr Cardiol. 2015;36(2):365–73.CrossRefPubMedGoogle Scholar
  4. 4.
    Ohye RG et al. Comparison of shunt types in the Norwood procedure for single-ventricle lesions. N Engl J Med. 2010;362(21):1980–92.CrossRefPubMedPubMedCentralGoogle Scholar
  5. 5.
    Cheatham SL, Carey H, Chisolm JL, Heathcock JC, Steward D. Early results of neurodevelopment following hybrid stage I for hypoplastic left heart syndrome. Pediatr Cardiol. 2015;36(3):685–91.CrossRefPubMedGoogle Scholar
  6. 6.
    Newburger JW et al. Early developmental outcome in children with hypoplastic left heart syndrome and related anomalies: the single ventricle reconstruction trial. Circulation. 2012;125(17):2081–91.CrossRefPubMedPubMedCentralGoogle Scholar

Copyright information

© Springer International Publishing Switzerland 2016

Authors and Affiliations

  1. 1.The Heart Center, Nationwide Children’s Hospital, Pediatrics & Internal Medicine, CardiologyThe Ohio State UniversityColumbusUSA

Personalised recommendations