Hybrid Stage I Palliation in a 1.1 kg, 28-Week Preterm Neonate With Posterior Malalignment Ventricular Septal Defect, Left Ventricular Outflow Tract Obstruction, and Coarctation of the Aorta

Abstract

The hybrid stage I procedure has emerged as a less-invasive alternative to the standard surgical Norwood procedure in the palliation of high-risk hypoplastic left heart syndrome and variants. This approach may also benefit patients requiring complex neonatal repair who have significant anatomic and/or perioperative risk factors that either prevent or complicate durable and robust biventricular circulation from being safely achieved. An extremely low-birth weight (1.1 kg) 28-week gestation preterm neonate with postnatal diagnosis of posterior malalignment ventricular septal defect, severe left ventricular outflow tract obstruction, aortic annular hypoplasia, and aortic arch obstruction underwent initial palliation with a hybrid stage I procedure. In this case, hybrid stage I palliation allowed for both somatic and left heart growth followed by ultimate uncomplicated biventricular repair.

First-stage palliation strategy for univentricular heart disease may impact risk for acute kidney injury

“…19 At our centre, the Hybrid strategy has generally been reserved for use in high-risk neonates with single ventricle and hypoplastic left heart syndrome or variant anatomy, although not all high-risk candidates undergo Hybrid palliation. 20 This strategy is reflected in the discrepancies in cohort makeup; the Hybrid cohort was smaller, contained more highrisk candidates, and showed biomarker evidence of greater renal injurythat is, levels of neutrophil gelatinase-associated lipocalin and interleukin-18preoperatively compared with the Norwood cohort. We hypothesise that the increased levels of preoperative biomarkers are reflective of the impact of prematurity, genetic anomalies, and overall high-risk status in the Hybrid cohort.…”

Innovative interventional catheterization techniques for congenital heart disease

“…Importantly, the hybrid stage I palliation has also been used successfully in the non-single ventricle population. For example, in patients with factors which might place them at higher risk of morbidity or mortality after major complex congenital heart repair during infancy, the stage I hybrid palliation can be used to stabilize the circulation and post-pone definitive anatomic repair until later in childhood (49,50).…”

Integration of Hybrid and Single Ventricle Rehabilitation Techniques to Treat a Neonate After Iatrogenic Mitral Injury

“…4 Hybrid techniques have been used to provide initial stabilization for patients who eventually undergo successful biventricular repair. 5,6 Balloon aortic valvulopasty has proved to be a reliable therapy for neonates with critical aortic stenosis. 7 While BAV remains our first-line therapy, other centers have demonstrated the utility of open surgical valvuloplasty with excellent results.…”

“…4 Hybrid techniques have been used to provide initial stabilization for patients who eventually undergo successful biventricular repair. 5,6…”