Objective: We present our initial clinical experience with hybrid procedure for HLHS, comparing the use of fixed x adjustable PA bands.
Methods: Between September 2004 and December 2008, we have performed Hybrid Stage I palliation for HLHS using adjustable PA bands (APAB group) in 3 patients weighing between 1.8-2.8 kg and traditional bands (TPAB group) in 3 patients weighing between 2.0–3.3 kg. Implantation of the APAB was straightforward from the technical standpoint. Fine adjustments of the pulmonary blood flow could be easily achieved percutaneously.
Results: The first APAB case demised during to interstage 1-2 (65 days old) due to atrioseptostomy complications. The second APAB case successfully completed the Fontan circulation at 2 years of age, and the third patient has reached the second stage (intraoperative death due to hemorrhagic complications). Regarding TPAB group, the first patient died at six months of life due to pulmonary infection and the two other cases underwent the second stage operation (intra and postoperative deaths). The graph shows the O2 sat behavior of both groups during interstage 1-2.
Conclusions: Customization of the pulmonary blood flow seemed to result in a more precise balance between the pulmonary and systemic circulations during the inter-stage period. The use of adjustable PA bands in the hybrid procedure for HLHS may favor a more stable condition of the patients during interstage 1-2, according to the rapid somatic growth and underlying clinical needs of the patient.