The following is the summary of “Hybrid strategy in neonates with ductal-dependent systemic circulation and multiple risk factors” published in the November 2022 issue of The Journal of Thoracic and Cardiovascular Surgery by Ceneri, et al.

The purpose of this study was to evaluate the effectiveness of a hybrid strategy for ductal-dependent systemic circulation, which includes bilateral pulmonary artery banding with or without ductal stenting, followed by delayed Norwood-type palliation or a comprehensive stage II operation in high-risk neonates. Between the months of December 2017 and March 2021, a retrospective investigation was conducted. Palliation with bilateral pulmonary artery banding was performed on 30 high-risk newborns, 11 of whom also received prostaglandin treatment, and 19 underwent ductal stenting. 

Patients at hybrid stage I had a median (range) age of 3 days (range, 0-43) and a median (range, 1.1-4.2) body weight of 2.9 kg (1.1-4.2). Mortality, morbidity, and readmission rates were calculated during and after surgery. At a median follow-up of 9 months (range, 0-37), overall survival from hybrid stage I was 70% (21/30). The overall operative survival rate was 90% (27/30), with 2 patients receiving palliative care and 1 death occurring between stages (4%, 1/27) in hybrid stage I. Three-and-a-half percent (37%; n=1) of patients required a second intervention after hybrid stage I and 3% (n=1) required extracorporeal membrane oxygenation before the next stage of repair. 

There are now 5 patients awaiting the completion of the Fontan procedure and 9 patients awaiting the completion of the second part of their operation. The hybrid method can successfully palliate high-risk infants with hypoplastic left heart syndrome or its variants and bridge them to a delayed Norwood or comprehensive stage II procedure with good survival. This operational method represents a promising alternative strategy in newborns with many preoperative risk factors.