• Nicolle M Ceneri, Manan H Desai, Aybala Tongut, Mahmut Ozturk, Karthik Ramakrishnan, Steven J Staffa, David Zurakowski, Mary T Donofrio, Tacy Downing, Yves d'Udekem, Richard A Jonas, Can Yerebakan, and Children's National Hospital Hybrid Working Group.
• Division of Cardiac Surgery, Children's National Hospital, The George Washington University, School of Medicine and Health Sciences, Washington, DC.
• J. Thorac. Cardiovasc. Surg. 2022 Nov 1; 164 (5): 1291-1303.e6.

ObjectiveThe study objective was to analyze outcomes of the hybrid strategy for ductal-dependent systemic circulation consisting of bilateral pulmonary artery banding with or without ductal stenting followed by delayed Norwood-type palliation or comprehensive stage II operation in high-risk neonates.MethodsA retrospective analysis was performed between December 2017 and March 2021. Thirty high-risk neonates underwent palliation with bilateral pulmonary artery banding: 11 with prostaglandin therapy and 19 with ductal stenting. Median (range) age and body weight of patients at hybrid stage I were 3 days (0-43) and 2.9 kg (1.1-4.2), respectively. Operative and interstage mortality, morbidity, and reintervention rates were assessed.ResultsOverall survival was 70% (21/30) at a median follow-up time of 9 months (range, 0-37) from hybrid stage I. Operative survival for hybrid stage I was 90% (27/30), of which 2 patients received palliative care, and there was 1 interstage death (4%, 1/27). After hybrid stage I, 37% of patients had a reintervention, and 3% (n = 1) used extracorporeal membrane oxygenation before the next stage of repair. Five patients are awaiting second-stage operation, and 9 patients are awaiting Fontan completion.ConclusionsHigh-risk neonates with hypoplastic left heart syndrome or its variants can be successfully palliated using the hybrid strategy and bridged to a delayed Norwood or comprehensive stage II operation with satisfactory survival. This operative approach is a promising alternative pathway for neonates deemed to be high risk due to multiple preoperative risk factors.Copyright © 2022 The American Association for Thoracic Surgery. Published by Elsevier Inc. All rights reserved.

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