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.