Objectives. The Hybrid procedure (Bilateral PA Bands + PDA stent) is an alternative treatment in HLHS. The cornerstone of this procedure is flow in the transverse arch. We report our experience with serial measurements of Troponin to evaluate the adequacy of transverse arch flow after the Hybrid procedure.

Methods. Patients who underwent the Hybrid procedure at our institution were retrospectively reviewed. Troponin levels were drawn shortly after the procedure, then every 8 hours for 48 hours, and subsequently every 24 hours for 3 days. Troponin levels were drawn thereafter if transverse arch inadequacy was suspected.

Results. From July 2007 through November 2008, 11 patients underwent the Hybrid procedure (7 HLHS, 2 IAA, 1 Heterotaxy, 1 aortic atresia/VSD). There were no operative mortalities. One patient died at 60 days post-Hybrid. Two patients underwent a Norwood/Glenn repair. Two had a biventricular repair. Two had a Sano procedure due to inadequate transverse arch flow, and four are awaiting repair. Troponin levels were followed in 7 cases. Median Troponin level at 1hr was 1.02 ng/ml, at 8hrs 2.5, at 16hrs 1.37 and at 24hrs 1.27, and 0.06 at discharge. The two patients requiring intervention had a 20% increase in Troponin level compared to levels at discharge which were equal to the post-operative nadir. Troponin level did not correlate with the measured gradient in the transverse arch.

Conclusions. Troponin level elevations occur after the Hybrid procedure but return to normal within one week. Late increase in Troponin may assist in the decision to re-intervene.