Hybrid Procedures for Congenital Heart Disease

Galantowicz, Mark; Cheatham, John P.; Phillips, Alistair; Holzer, Ralf; Hill, Sharon L.; Olshove, Vincent

doi:10.1002/9781118320754.ch5

Cited by 2 publications

(5 citation statements)

References 85 publications

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“…However, advanced cardiopulmonary bypass surgery within the endangered neonatal period is avoided [10,31]. The Hybrid surgical-interventional approach must achieve adequate systemic blood flow through an unobstructed arterial duct and a free aortic arch through ductal stenting or continuous long-term prostaglandin E1 infusion [32][33][34]. The lungs are protected by attaching left and right pulmonary artery branch banding [31,32] in order to achieve a balanced pulmonary and systemic circulation, provided that the atrial communication is not obstructed.…”

Section: Current Hybrid Procedures and Follow-up Resultsmentioning

confidence: 99%

“…The Hybrid surgical-interventional approach must achieve adequate systemic blood flow through an unobstructed arterial duct and a free aortic arch through ductal stenting or continuous long-term prostaglandin E1 infusion [32][33][34]. The lungs are protected by attaching left and right pulmonary artery branch banding [31,32] in order to achieve a balanced pulmonary and systemic circulation, provided that the atrial communication is not obstructed. Since the use of PTFE strips [32], the procedure has been simplified and some historical problems with the potential for loss of the left superior pulmonary artery segment during de-banding have been nearly resolved.…”

Section: Current Hybrid Procedures and Follow-up Resultsmentioning

confidence: 99%

“…The lungs are protected by attaching left and right pulmonary artery branch banding [31,32] in order to achieve a balanced pulmonary and systemic circulation, provided that the atrial communication is not obstructed. Since the use of PTFE strips [32], the procedure has been simplified and some historical problems with the potential for loss of the left superior pulmonary artery segment during de-banding have been nearly resolved. However, most surgeons prophylactically patch the LPA or insert a stent during the comprehensive stage-II procedure to avoid postoperative problems with the LPA [32].…”

Section: Current Hybrid Procedures and Follow-up Resultsmentioning

confidence: 99%

“…Since the use of PTFE strips [32], the procedure has been simplified and some historical problems with the potential for loss of the left superior pulmonary artery segment during de-banding have been nearly resolved. However, most surgeons prophylactically patch the LPA or insert a stent during the comprehensive stage-II procedure to avoid postoperative problems with the LPA [32]. Right from the start, the GHA concept was based from the beginning on a sequential procedure starting with bilateral PAB as an open-chest surgery followed by elective duct stenting and needs-based manipulation of the atrial septum or the aortic isthmus as a percutaneous transcatheter measure [10,11,35].…”

Section: Current Hybrid Procedures and Follow-up Resultsmentioning

confidence: 99%

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Hypoplastic Left Heart: Stage-I Will be Performed Interventionally, Soon

2021

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The hypoplasia of left-sided heart structures shows great variability and complexity. What the many variants have in common is that their heart structures are neither fully developed before nor after birth. Fetuses and newborns require an individual therapy depending on anatomy and function of the heart. Fetal interventions focus on improving left heart structures by catheter-based interventions and maternal hyperoxygenation which promotes growth as the left ventricular preload and blood flow within the cavity increase. Stage-I management of newborns with single ventricle physiology is usually based on the Norwood/Sano surgery or the Hybrid approach. Two more steps are required to ultimately achieve a Fontan circulation. Some centers also use the Hybrid approach for subsequent Norwood operation beyond the neonatal period. After the Hybrid approach, a comprehensive stage-II or corrective surgery is performed, the latter if a bi-ventricular circulation is possible. With progressively improved catheter-based interventions, particularly ductal stenting and manipulations of the atrial septum, the next advance is to develop a bespoke flow restrictor that can be easily inserted into the branches of the pulmonary artery. The main goal is to avoid complex heart operations under general anesthesia, followed by substantial intensive care in the neonatal period, especially for patients with complex heart defects. Based on the current state of the art of surgical treatment of hypoplastic left heart syndrome and variants with the Norwood surgery or the Hybrid approach, our main focus is on an alternative percutaneous transcatheter technique in the sense of a completely non-surgical stage-I approach.

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Section: Current Hybrid Procedures and Follow-up Resultsmentioning

confidence: 99%

Section: Current Hybrid Procedures and Follow-up Resultsmentioning

confidence: 99%

Section: Current Hybrid Procedures and Follow-up Resultsmentioning

confidence: 99%

Section: Current Hybrid Procedures and Follow-up Resultsmentioning

confidence: 99%

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Hypoplastic Left Heart: Stage-I Will be Performed Interventionally, Soon

2021

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“…Currently, no conduit can meet the long-term functional requirements, especially the small-sized (≤16 mm) conduit used in infants and young children. In addition, the standard surgical timing of critical congenital heart disease has shifted to an earlier stage, with most patients having surgical treatment in the first year after birth (2). Furthermore, the Ross operation has been widely applied in pediatric patients (3).…”

Section: Introductionmentioning

confidence: 99%

Conduits for Right Ventricular Outflow Tract Reconstruction in Infants and Young Children

et al. 2021

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Purpose of Review: Right ventricular outflow tract (RVOT) reconstruction remains a challenge due to the lack of an ideal conduit. Data and experience are accumulating with each passing day. Therefore, it is necessary to review this topic from time to time. This is a 2021 update review focused on the history, evolution, and current situation of small-sized conduits (≤ 16 mm) for RVOT reconstruction in infants and young children.Recent Findings: Currently, the available small-sized (≤16 mm) conduits can meet most clinical needs. Homograft is still a reliable choice for infants and young children validated by a half-century clinical experience. As an alternative material, bovine jugular vein conduit (BJVC) has at least comparable durability with that of homograft. The performance of expanded polytetrafluoroethylene (ePTFE) is amazing in RVOT position according to limited published data. The past century has witnessed much progress in the materials for RVOT reconstruction. However, lack of growth potential is the dilemma for small-sized conduits. Tissue-engineering based on cell-free scaffolds is the most promising technology to obtain the ideal conduit.Summary: No conduit has proved to have lifelong durability in RVOT position. We are far from the ideal, but we are not in a state of emergency. In-depth clinical research as well as innovation in material science are needed to help improve the durability of the conduits used in infants and young children.

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Hybrid Procedures for Congenital Heart Disease

Cited by 2 publications

References 85 publications

Hypoplastic Left Heart: Stage-I Will be Performed Interventionally, Soon

Hypoplastic Left Heart: Stage-I Will be Performed Interventionally, Soon

Conduits for Right Ventricular Outflow Tract Reconstruction in Infants and Young Children

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