Hybrid Pediatric Cardiac Surgery

Abstract

Minimally invasive strategies can be expanded by combining standard surgical and interventional techniques. We performed a longitudinal prospective study of all pediatric patients who have undergone hybrid cardiac surgery at the University of Chicago Children's Hospital. Hybrid cardiac surgery was defined as combined catheter-based and surgical interventions in either one setting or in a planned sequential fashion within 24 hours. Between June 2000 and June 2003, 25 patients were treated with hybrid approaches. Seventeen patients with muscular ventricular septal defects (mVSDs) (mean age, 4 months; range, 2 weeks-4 years) underwent either sequential Amplatzer device closure in the catheterization laboratory followed by surgical completion (group 1A, n = 9) or one-stage intraoperative off-pump device closure (group IB, n = 8) with subsequent repair of any concomitant heart lesions. Eight patients with branch pulmonary artery (PA) stenoses (group 2) underwent intraoperative PA stenting or stent balloon dilatation along with concomitant surgical procedures. All patients survived hospitalization. Complications from the hybrid approach were mostly confined to groups 1A and 2. At a mean follow-up of 18 months, 2 group 1A patients died suddenly several months after discharge. All other patients are doing well. Hybrid pediatric cardiac surgery performed in tandem by surgeons and cardiologists is safe and effective in reducing or eliminating cardiopulmonary bypass. Patients with mVSDs who are small, have poor vascular access, or have concomitant cardiac lesions are currently treated in one setting with the perventricular approach.

Mid‐term follow up of perventricular device closure of muscular ventricular septal defects

“…Several reports describe the successful use of the hybrid procedure to close a MVSD [14][15][16][17][18]; however, because of the relative novelty of the approach and the small number of eligible patients, long-term follow up is limited. Few studies describe follow up beyond 2 years.…”

“…Since its initial description in 1998 by Amin et al [13], there have been several reports from different institutions describing the experience with the perventricular approach and echocardiography follow up. However, these reports detail procedural or shortterm results, with no follow up reported beyond 22 months [14][15][16][17][18].…”

Creation of Ventricular Septal Defects on the Beating Heart in a New Pig Model

“…Recently, interventional therapy for closure of mVSDs has shown promising results [12,14,15] . However, major limitations are the challenging procedures, low patient weight or poor vascular access [11] . Additionally, rhythm disturbances and hemodynamic instability especially in small infants have been reported [14] .…”

“…Furthermore, surgery requires extracorporeal circulation (ECC), which may be associated with different adverse effects [8][9][10] . The alternative of interventional strategies are limited by poor vascular access, especially in small infants [11] . The use of big sheaths can cause severe rhythm disturbances and hemodynamic deterioration during the procedure.…”

Stents as an Option for the Correction of Congenital Heart Disease

“…В сравнении с классическими хирургическими методами интраопе-рационное стентирование ЛА также выигрывает по сте-пени инвазивности за счет существенного сокращения длительности времени сердечно-легочного шунтирова-ния [39]. Кроме того, его преимуществом является отсут-ствие требований к высокотехнологичному оснащению операционной, так как имплантация стента может быть проведена под визуальным контролем.…”