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 TJniversity 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 wilh 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 surgieal completion (group IA, n ^ 9) or one-stage intraoperative olTpump 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 surgieal procedures. All patients survived hospitalization. Complications from the hybrid approach were mostly confined to groups IA and 2. At a mean follow-up of 18 months, 2 group IA 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 pcrventricular approach.Although surgery remains the treatment of choice for most congenital cardiac malformations, interventional cardiology approaches are increasingly being Correspondence uehieago.edu to: E.A. Bacha, email: ebacha(a;surgery.bsd.

Patch Closure of Muscular Ventricular Septal Defects With a New Hybrid Therapy in a Pig Model

“…Advantages over open repair included avoidance of trans-section of the moderator band or other right ventricular muscle bundles without limitations of vascular access or patient weight (14). Nevertheless, authors also reported valve injuries, device embolization into the aorta, and rhythm disturbances (10).…”

“…Hybrid cardiac surgery, a combination of interventional and surgical techniques, has been demonstrated as a new, innovative approach for therapy of mVSDs, because it reduces operation times, complexity, operative trauma, and avoids use of CPB (10,14). Several authors reported off-pump closure of mVSDs with an Amplatzer device via a perventricular approach.…”

“…In general, hybrid therapy, a combination of interventional and surgical techniques, seems to be a new innovative approach for therapy of mVSDs (10). So far, both surgical and interventional therapies for mVSDs have their limitations.…”

“…Owing to technical difficulties, for many mVSDs below the moderator band pulmonary artery banding (PAB) is the preferred therapy in order to postpone corrective surgery. Interventional therapies are often limited by poor vascular access, low patient weight, and rhythm disturbances (10).…”

New surgery for better outcomes: shaping the field of congenital heart disease

“…[5] Interventional pediatric cardiologists have been performing catheter interventions since the early 1980s, but have now brought their New surgery for better outcomes: shaping the fi eld of congenital heart disease Jacques G Leblanc…”