Hybrid Approach: The Columbus Way
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.
KeywordsPatent Ductus Arteriosus Hypoplastic Left Heart Syndrome Left Pulmonary Artery Neurodevelopmental Outcome Balloon Atrial Septostomy