Hypoplastic Left Heart Syndrome Palliation: Technical Aspects and Common Pitfalls of the Hybrid Approach

Abstract

The Giessen hybrid strategy is used for initial palliation of HLHS and variants when the intent is to pursue further staged palliative reconstruction toward Fontan circulation. It is also used for initial palliation of HLHC and other anomalies with potential for eventual biventricular repair. From June 1998 - October 2021, 197 patients with HLHS and related variants underwent hybrid stage 1. Follow-up is complete (median 8.3 [range 0-23.3] years). Operative mortality for hybrid stage I was 3.6% (7/197); reduced to 2.8% since 2010 (4/141). Interstage mortality was 4.1% (8/197). Operative mortality for comprehensive stage II was 5.8% (10/172), and since 2010 was 1.8% (2/113 patients). Fontan completion has been accomplished in 117 patients, and 33 are still awaiting stage III. Twelve patients underwent heart transplantation. Over 23 years, overall survival is 77.7% and transplant-free survival is 73.6%.

Keywords

hypoplastic left heart syndrome hybrid approach hybrid palliation functionally univentricular heart

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References

Wilder

McCrindle

Hickey

, et al.

Is a hybrid strategy a lower-risk alternative to stage I Norwood operation?

J Thorac Cardiovasc Surg. 2017;153(1):163‐172. e6.

Jacobs

Mayer

Jr Mavroudis

, et al. The Society of Thoracic Surgeons Congenital Heart Surgery database: 2017 update on outcomes and quality. Ann Thorac Surg. 2017;103(3):699‐709.

Uygar

Hakan

. Giessen procedure as comprehensive stage II palliation with aortic arch reconstruction after hybrid bilateral pulmonary artery banding and ductal stenting for hypoplastic left heart syndrome. Semin Thorac Cardiovasc Surg Pediatr Card Surg Annu. 2018;21:19‐27.

Ohye

Schranz

D'Udekem

. Current therapy for hypoplastic left heart syndrome and related single ventricle lesions. Circulation. 2016;134(17):1265‐1279.

Akintuerk

Michel-Behnke

Schranz

, et al. Stenting of the arterial duct and banding of the pulmonary arteries: basis for combined Norwood stage I and II repair in hypoplastic left heart. Circulation. 2002;105(9):1099‐1103.

Yerebakan

Schranz

Akintürk

, et al.

Hybrid therapy for hypoplastic left heart syndrome for hypoplastic left heart syndrome; myth, alternative or standard?

J Thorac Cardiovasc Surg. 2016;151(4):1112–21, 1123.e1–5.

Murphy

Bellsham-Revell

Morgan

, et al. Hybrid procedures for neonates with hypoplastic left heart syndrome at high risk for Norwood: midterm outcomes. Ann Thorac Surg. 2015;100(6):2286‐2290; discussion 2291-2.

Galantowitcz

Cheatham

Phillips

, et al. Hybrid approach after for hypoplastic left heart syndrome: intermediate results after the learning curve. Ann Thorac Surg. 2008;85(6):2063‐2070; discussion 2070-1.

Yerebakan

Schranz

Akintürk

, et al. Long-term results of biventricular repair after initial Giessen hybrid approach for hypoplastic left heart variants. J Thorac Cardiovasc Surg. 2015;149(4):1112‐1120; discussion 1120–2-e2.