Methods and Materials
Ethical and institutional approval was obtained. In our institution,
hybrid palliation is performed in three main groups: a) infants ≤ 2.7kg
b) poor pre-morbid condition or with significant risk factors for
Norwood Procedure (significant tricuspid regurgitation, right
ventricular dysfunction, neurological or multi-organ dysfunction after
presentation) and c) ‘borderline’ left heart structures where
biventricular repair was felt to be possible in the future.
Via a median sternotomy, pulmonary artery bands fashioned from a cut
section of Gortex shunt are placed around each branch pulmonary artery
and secured. A sheath is then introduced directly to the pulmonary
artery and the stent deployed under fluoroscopic guidance. Our usual
practice is not to perform an atrial septal intervention at the time of
HP unless there is evidence of atrial restriction prior to the procedure
as defined by a high mean atrial gradient with A wave reversal on
pulmonary venous Dopplers along with clinical evidence with chest x-ray
congestion and low saturations.
After HP, patients are assessed on an individual basis. In this era
according to surgeon preference, some will undergo a Hybrid to Norwood
conversion procedure and then a later hemi-Fontan (HF), or if deemed
unsuitable for an early Norwood (e.g. aberrant right subclavian artery,
significant tricuspid regurgitation or impaired right ventricular
systolic function), may undergo a comprehensive second stage (CSII)
consisting of a Damus-Kaye-Stansel anastomosis, reconstruction of the
aortic arch and HF at around 6 months of age.