New Therapeutic Avenues with Hybrid Pediatric Cardiac Surgery

ACC/AHA 2006 Guidelines for the Management of Patients With Valvular Heart Disease

“…Surgery has usually involved mechanical or biological valve replacement (see Sections 3.2.3.8 and 7.2), but some have performed the Ross operation or aortic valve repair. Although not all valves are amenable to repair, some success has been reported for AR after balloon dilation (100% freedom from reoperation at 1 year and 80% from reintervention at 3 years) (826) and with a prolapsing leaflet (freedom from reoperation of 95%, 87%, and 84% at 1, 5, and 7 years, respectively) (827). Aortic valve repair is a viable alternative in some centers and may be preferred in the future, but in view of the relative youth of the patients and lack of long-term durability of valve repair or replacement with biological valves, these alternatives to mechanical valve replacement may be appropriate only for those with a contraindication to anticoagulation in the majority of centers.…”

2008 Focused Update Incorporated Into the ACC/AHA 2006 Guidelines for the Management of Patients With Valvular Heart Disease

“…Although not all valves are amenable to repair, some success has been reported for AR after balloon dilation (100% freedom from reoperation at 1 year and 80% from reintervention at 3 years) 826 and with a prolapsing leaflet (freedom from reoperation of 95%, 87%, and 84% at 1, 5, and 7 years, respectively). 827 Aortic valve repair is a viable alternative in some centers and may be preferred in the future, but in view of the relative youth of the patients and lack of long-term durability of valve repair or replacement with biological valves, these alternatives to mechanical valve replacement may be appropriate only for those with a contraindication to anticoagulation in the majority of centers.…”

Surgical Update

“…Percutaneous interventional techniques can be difficult to perform as a result of small patient size and difficulties with vascular access and the presence of congenital anatomic variations, 31 such as transposition of the great vessels, double-outlet right ventricle, or tortuous pulmonary artery anatomy associated with the tetralogy of Fallot. 31 Such constraints may limit or complicate the performance of percutaneous interventional techniques.…”

“…Percutaneous interventional techniques can be difficult to perform as a result of small patient size and difficulties with vascular access and the presence of congenital anatomic variations, 31 such as transposition of the great vessels, double-outlet right ventricle, or tortuous pulmonary artery anatomy associated with the tetralogy of Fallot. 31 Such constraints may limit or complicate the performance of percutaneous interventional techniques. 31 However, surgical intervention also can have its limits in scenarios such as closure of multiple apical muscular ventricular septal defects, management of a previously deployed stenotic stent, or maintenance of adequate long-term relief of peripheral pulmonic stenosis.…”

“…31 Such constraints may limit or complicate the performance of percutaneous interventional techniques. 31 However, surgical intervention also can have its limits in scenarios such as closure of multiple apical muscular ventricular septal defects, management of a previously deployed stenotic stent, or maintenance of adequate long-term relief of peripheral pulmonic stenosis. 32 Thus, an integrated hybrid approach where surgical and interventional techniques are combined could offer the benefits of both modes of therapy and help to overcome such limitations.…”