Hybrid First-stage Palliation and Other Strategies to Achieve Biventricular Repair in High-Risk Neonates With Complex Heart Anomalies and Aortic Arch Obstruction

Medical and surgical advances have allowed single-stage total repair in neonates born with complex congenital heart anomalies and aortic arch obstruction. Nonetheless, total repair might be too complex or high risk in certain neonates with demographic, clinical or morphologic risk factors. Alternati...

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Bibliographic Details
Published in:Seminars in thoracic and cardiovascular surgery. Pediatric cardiac surgery annual 2023, Vol.26, p.40-49
Main Author: Alsoufi, Bahaaldin
Format: Article
Language:English
Subjects:
Aortic Arch Obstruction
Biventricular Repair
Branch Pulmonary Artery Band
Ductal Stent
Hybrid First-Stage Palliation
Interrupted Aortic Arch
Left Ventricular Outflow Tract Obstruction
Stage 1 Hybrid Palliation
Taussig-Bing
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Summary:Medical and surgical advances have allowed single-stage total repair in neonates born with complex congenital heart anomalies and aortic arch obstruction. Nonetheless, total repair might be too complex or high risk in certain neonates with demographic, clinical or morphologic risk factors. Alternative management strategies might offer these neonates better outcomes with superior anatomic repair, shorter hospitalization, reduced morbidity, and improved survival. Alternative initial surgical strategies might include aortic arch repair and pulmonary artery band with or without cardiopulmonary bypass, extracardiac repair only and pulmonary artery band, Norwood operation, and hybrid first-stage palliation; all deferring complex biventricular intra-cardiac repair to later stage. The strategy choice should be personalized to each patient, taking into consideration the morphologic and clinical state, and the existent goals of care.
ISSN:1092-9126
DOI:10.1053/j.pcsu.2022.12.009