Intraoperative hybrid cardiac surgery for neonates and young children with congenital heart disease: 5 years of experience.

OBJECTIVE: This study intends to summarize 5 years of intraoperative hybrid procedure (IHP) experience with neonates and young children having congenital heart disease (CHD). METHODS: From March 2003 to March 2009, a total of 152 consecutive patients younger than 2 years old who had undergone IHP were enrolled. In the balloon plasty group (n = 72), transventricular pulmonary valvuloplasty, or transaortic balloon dilatation were performed for pulmonary atresia, pulmonary stenosis, or coactation of the aorta. In the device group (n = 43), transventricular device closure was performed for ventricular septal defect (VSD), or transatrial device closure for atrial septal defect (ASD). In the collateral arteries occlusion group (n = 37), the major aortopulmonary collateral arteries (MPCAs) were occluded with coils for tetralogy of Fallot or other cyanotic CHDs. All procedures were image guided and performed in a specially designed hybrid operation room. All surviving patients were followed up, and the major adverse cardiovascular events that occurred were recorded. RESULTS: In the balloon plasty group, all patients received successful transventricular valvuloplasty or transaortic balloon angioplasty. However, severe right ventricle outflow obstruction was observed in 2 cases. One patient was transferred to regular open-heart surgery immediately, and another underwent regular open-heart procedure after discharge. Furthermore, 1 neonate with pulmonary atresia with intact ventricular septum died from liver failure 6 months after IHP. In the device closure group, the device closure failed to be performed in 3 cases (2 with ASD and 1 with VSD). One young child with VSD died from pneumonia, even after successful device closure. No device malposition was observed in the device closure group during follow-up. All patients who received MPCA occlusion and associated open-heart correction were eventually discharged. CONCLUSION: IHP could avoid or shorten the application of cardiopulmonary bypass and reduce surgical trauma for selected young children with CHD. Although IHP is feasible and safe, the image outfits, image-guided technology, and IHP-related devices should be developed and improved.

[One-stop hybrid cardiac surgery for neonates and young children with congenital heart disease].

OBJECTIVE: To summarize our 5 years experiences of one-stop hybrid procedure (OHP) for the management of congenital heart disease (CHD) in neonates and young children (< 2 years old). METHODS: Clinical data derived from consecutive 152 young children and neonates with CHD underwent OHP between March 2004 to March 2009 were analyzed. Patients were divided into 3 groups: Balloon plasty group (n = 72), device closure group (n = 43) and collateral arteries occlusion group (n = 37). All procedures were image-guided and performed in a specially designed hybrid operation room. Incidence of major adverse cardiovascular events was obtained. RESULTS: Patients received successful per-ventricular valvuloplasty or per-aortic balloon angioplasty in balloon plasty group. Two patients in this group with severe right ventricle outflow obstruction received regular open-heart outflow tract reconstruction immediately (n = 1) or selective conventional open-heart operation after discharge (n = 1). One neonate with pulmonary atresia with intact ventricular septum died from liver failure 6 month after OHP. In device closure group, device closure was failed in 3 cases (2 with atrial and 1 with ventricular septum defects), 1 young child with ventricular septum defects died from pneumonia after successful device closure. No device malposition was observed in device closure group during the follow-up. All patients received major collateral arteries occlusion and open-heart correction were discharged without complication. CONCLUSION: OHP could avoid or shorten the application of cardiopulmonary bypass and reduce the surgical trauma in selected young children with CHD. Although OHP was feasible and safe, the image outfits, image-guided technology and OHP-related device should be further developed and improved for better procedure outcome.