Modified Hybrid Procedure in Hypoplastic Left Heart Syndrome: Initial Experience of a Center in Northeastern Brazil

Abstract

IntroductionAlthough it only corresponds to 2.5% of congenital heart defects, hypoplastic left heart syndrome (HLHS) is responsible for more than 25% of cardiac deaths in the first week of life. Palliative surgery performed after the second week of life is considered an important risk factor in the treatment of HLHS.ObjectiveThe aim of this study is to describe the initial experience of a medical center in Northeastern Brazil with a modified off-pump hybrid approach for palliation of HLHS.MethodsFrom November 2012 through November 2015, the medical records of 8 patients with HLHS undergoing hybrid procedure were retrospectively evaluated in a tertiary private hospital in Northeastern Brazil. The modified off-pump hybrid palliation consisted of stenting of the ductus arteriosus guided by fluoroscopy without contrast and banding of the main pulmonary artery branches. Demographic and clinical variables were recorded for descriptive analysis.ResultsEight patients were included in this study, of whom 37.5% were female. The median age and weight at the time of the procedure was 2 days (p25% and p75% = 2 and 4.5 days, respectively) and 3150 g (p25% and p75% = 3077.5 g and 3400 g, respectively), respectively. The median length in intensive care unit stay was 6 days (p25% and p75% = 3.5% and 8 days, respectively). There were no in-hospital deaths. Four patients have undergone to the second stage of the surgical treatment of HLHS.ConclusionIn this series, the initial experience with the modified off-pump hybrid procedure showed to be safe, allowing a low early mortality rate among children presenting HLHS.

Extracorporeal Membrane Oxygenation After Norwood Surgery in Patients With Hypoplastic Left Heart Syndrome: A Retrospective Single-Center Cohort Study From Brazil

“…According to Mesher et al ( 18 ) neonates with single-ventricle heart disease represent one of the most challenging groups of patients to manage. Other Brazilian publications on HLHS are represented by a few cases and are more related to the hybrid approach ( 19 , 20 ).…”

Management of Hypoplastic Left Heart Syndrome in Low-Resource Settings and the Ethics of Decision-Making

“…The neonate survived to hospital discharge. In another low-resource setting in north-eastern Brazil, 14 the hybrid approach was adopted as initial palliation for HLHS based on lower cost, no requirement for cardiopulmonary bypass, and limited experience with the Norwood procedure. From 2012 to 2015, eight neonates with HLHS were treated by this approach.…”

“…Four patients have undergone the second stage of the surgical treatment of HLHS. 14 The hybrid approach thus served as a viable option in settings where results of the Norwood procedure were suboptimal but facilities existed for the hybrid approach. Others have safely performed the hybrid stage I palliation for a hypoplastic left heart condition (aortic atresia with ventricular septal defect) in a two-month-old infant using minimal resources in a conventional catheterization laboratory.…”

The Evolution of Therapeutic Strategies: Niche Apportionment for Hybrid Palliation

“…Several emerging programs have switched to hybrid palliation driven by the high mortality of the Norwood procedure and stressed that this new approach still necessitated structural, conceptual, and technical skills to achieve good outcome [10][11][12]. By now, our specialty has gained experience with this palliative concept for almost 2 decades.…”