Hybrid Versus Norwood Strategies for Single-Ventricle Palliation

Abstract

Background-Hybrid

Aortopulmonary Collateral Flow is Related to Pulmonary Artery Size and Affects Ventricular Dimensions in Patients After the Fontan Procedure

“…The impact of aortopulmonary shunt procedures as well as the potential effects of a bilateral pulmonary artery banding on pulmonary artery growth, distorsion and reintervention rates needs to be investigated in further studies. Recently, Baba and colleagues compared Norwood-and Hybrid-procedure in the palliation of hypoplastic left heart syndrome (HLHS) and found significant differences in re-intervention rates and pulmonary artery size at the time of BCPC [15]. Our data showed a similar trend as a combined approach with stenting of the arterial duct and placement of bilateral pulmonary artery banding had been performed only in 2 patients in group 1 but in 8 patients in group 2, a result that suggests an increased presence of APCs in patients after the hybrid procedure while not being significant due to the small sample size in this subpopulation.…”

Surgical Palliation Strategy Does Not Affect Interstage Ventricular Dysfunction or Atrioventricular Valve Regurgitation in Children With Hypoplastic Left Heart Syndrome and Variants

“…1,2 Nonetheless, interstage death and the need for heart transplantation between stage I and stage II palliation is still significant, resulting in 1-year transplant-free survival of ≈70%. 3,4 Recent surgical modifications, namely the Sano procedure 5 with a right ventricle-pulmonary artery conduit and the Hybrid procedure, 6,7 have failed to show substantial survival advantages over the standard Norwood strategy. 3,4 Multiple anatomic and physiologic risk factors for interstage death have been identified, including arrhythmia, 8 ventricular dysfunction, 9 and atrioventricular valve regurgitation (AVVR).…”

“…3,4 Recent surgical modifications, namely the Sano procedure 5 with a right ventricle-pulmonary artery conduit and the Hybrid procedure, 6,7 have failed to show substantial survival advantages over the standard Norwood strategy. 3,4 Multiple anatomic and physiologic risk factors for interstage death have been identified, including arrhythmia, 8 ventricular dysfunction, 9 and atrioventricular valve regurgitation (AVVR). 10 All surgical palliation strategies for HLHS were primarily designed to improve stage I survival, and therefore the impact of stage I surgical palliation strategies on ventricular function is poorly understood.…”

The Fontan Circulation: The Known, the Unknown and the Plausible

“…When compared, in a short-term retrospective study of 75 infants, the survival rates were shown to be similar in these two groups, but there is a higher need for re-intervention of the pulmonary arteries to achieve satisfactory pulmonary artery growth in the hybrid group [5]. As explained before, this ultimately determines the long-term outcome.…”