PEDIATRIC AND CONGENITAL HEART DISEASE Original Studies Hybrid Approach for Pulmonary Atresia With Intact Ventricular Septum: Early Single Center Results and Comparison to the Standard Surgical Approach

Objectives: To examine acute and mid-term patient outcomes following the hybrid approach to pulmonary atresia with intact ventricular septum (PA-IVS) compared with the standard surgical approach. Background: A subset of PA-IVS patients with the prospect of biventricular circulation typically undergo surgical or transcatheter right ventricular (RV) outflow tract opening. A recently described hybrid procedure, involving perventricular pulmonary valve perforation, was shown to be safe and effective in single-center series. Methods: A single-center retrospective review of all patient with PA-IVS who underwent either surgical or hybrid RV decompression between January 2002 and December 2011 was completed and acute and mid-term patient outcomes were compared between the surgical and hybrid cohorts. Additionally, a systematic literature review was completed to compare a transcatheter cohort to the hybrid cohort. Results: Seven patients with PA-IVS underwent a hybrid procedure; the procedure was technically successful in all attempts, and none required CPB. No patients required surgical reintervention prior to hospital discharge, and none died during the study period. Surgical RV decompression was performed in 17 patients with a median CPB time of 80 min. Patient outcomes were nearly identical between cohorts. By systematic review, the transcatheter approach has a procedural success of 75–95% but up to 75% of patients require operation in the neonatal period. Conclusions: The hybrid approach is a safe and feasible alternative to the standard surgical and transcatheter approaches to PA-IVS. Acute and mid-term patient outcomes are comparable with those treated with a standard surgical approach and neonatal CPB is completely avoided. VC 2013 Wiley Periodicals, Inc.