Hybrid procedure and collaborative approach for hypoplastic left heart syndrome

Excerpt

In many cardiac centers dealing with simple and complex congenital heart disease, it has been a commonplace to embrace collaboration between cardiac surgeons and pediatric cardiologists. Most patients have undergone repair/palliation by cardiac surgeons, rendering their anatomy/hemodynamics/general status/operative indications evaluated by cardiologists from the patient’s fetal period to adulthood. After the surgery, the patients have had to be followed up again by cardiologists. To date, cardiac surgeons are essentially to be found in the catheterization laboratory providing advice and surgical backup. Alternatively, interventional cardiologists work hand in hand with their surgical colleagues utilizing specific catheter-based techniques in the operating room, which has been regarded as a “hybrid procedure”. Over the past decade, this joint work has become sophisticated, taking place in a “hybrid catheterization suite” or a “hybrid OR”. The former includes wide-mobility biplane flat panel detectors and the latter includes a single C-arm equipped with the operating table. Advantages of such approach include: avoidance of large sheaths introduced by femoral or cervical punctures, less hemodynamic compromise by crossing with stiff wire/catheter/sheath assembly through intra-cardiac structures and possible conversion to on-pump procedure if the necessity arise. It can minimize the risk of complex interventional procedures especially in tenuous condition and small infants. …