Hybrid Strategy in the Management of Congenital Heart Defects. Initial Results in a Multicenter Experience

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Abstract

Background: The hybrid approach implies the close collaboration between surgical and interventional cardiology teams for the treatment of complex congenital heart diseases, to reduce the number of interventions by using less invasive techniques, avoid the limitations due to the size of vascular accesses and the use of cardiopulmonary bypass.

Objectives: The aim of this study is to evaluate the indications, techniques, initial results and short-term follow-up of the hybrid approach.

Methods: We conducted a retrospective analysis of patients treated with hybrid approach between March 2014 and September 2020. Fourteen procedures were performed in 13 patients. Mean age was 16.8 months (1 day-13 years); 50% were neonates, 57% were male and mean weight was 9 kg (1.9-70 kg). The hybrid procedures performed included stenting in coarctation of the aorta (4 patients), ductal stenting (3 patients), stenting of pulmonary artery branches (1 patient), neonatal aortic valvuloplasty (4 patients) and perventricular closure of muscular ventricular septal defect (2 patients). The access used was dissection of the carotid artery in 8 procedures and sternotomy in the remaining 6.

Results: All the procedures were successfully completed, except for two patients: one died due to ventricular fibrillation after the pro cedure, and another in the immediate postoperative period due to severe coagulation abnormality. Mean follow-up of the remaining 12 patients was 19 months with favorable outcome.

Conclusions: The initial results with the use of a hybrid strategy were satisfactory in terms of survival and improvement of the he modynamic parameters. The selection of cases, teamwork and appropriate follow-up are key factors to achieve satisfactory results.