Hybrid Procedures Can Reduce the Risk of Congenital Cardiovascular Surgery

  • Dr Christoph Schmitz, Department of Cardiac Surgery, University of Munich, Germany, Germany
  • Dr Bahman Esmailzadeh, Department of Cardiac Surgery, University of Bonn, Germany, Germany
  • Dr Ulrike Herberg, Department of Pediatric Cardiology, University of Bonn, Germany, Germany
  • Dr Nora Lang, Department of Pediatric Cardiology, University of Munich, Germany, Germany
  • Dr Ralf Sodian, Department of Cardiac Surgery, University of Munich, Germany, Germany
  • Dr Rainer Kozlik-Feldmann, Department of Pediatric Cardiology, University of Munich, Germany, Germany
  • Prof Armin Welz, Department of Cardiac Surgery, University of Bonn, Germany, Germany
  • Dr Johannes Breuer, Department of Pediatric Cardiology, University of Bonn, Germany, Germany

    • Objective: Minimally invasive operations and percutaneous interventions are well-accepted options in the treatment of congenital heart defects. However, percutaneous interventions may be associated with an increased risk due to limited vascular access or a very tortuous catheter course. In these cases, combining operative and interventional approaches with direct puncture of the heart or the great vessels may facilitate implantation of even large devices.

    Methods: Between 01/2000 and 04/2007 17 patients were operated in a hybrid fashion. Age ranged from 14 days to 45 years. Operative procedures consisted of implantation of ASD or VSD occluders (n=5), implantation or re-dilation of isthmus or ductal stents (n=7), angioplasty of the PA (n=2), stent implantation into the PA or RVOT (n=2), occlusion of an intrahepatic porto-caval shunt (n=1), and atrioseptoplasty combined with a bilateral PA banding in a newborn with a SV and very low birth weight (n=1).

    Results: In all cases, the primary hemodynamic objectives were achieved. The Aristotle Basic Score dropped significantly from 6.75 ± 2.43 (theoretical score without intervention) to 5.38 ± 2.70 (actual score with intervention) (p=0.001), the expected mortality according to the EACTS database from 7.09 ± 6.18 % (theoretical mortality risk without intervention) to 3.80 ± 3.60 % (actual mortality risk with intervention) (p=0.005).

    Conclusions: In selected patients, the combination of a surgical procedure and a percutaneous intervention may help to reduce both operative and interventional risks. This concept may enable new treatment options, especially in patients with complex congenital heart defects or complex vascular situations.