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Polish Journal of Thoracic and Cardiovascular Surgery
eISSN: 1897-4252
ISSN: 1731-5530
Kardiochirurgia i Torakochirurgia Polska/Polish Journal of Thoracic and Cardiovascular Surgery
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2/2025
vol. 22
 
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abstract:
Original paper

Pitfalls in hybrid procedures in newborns with left-sided obstructive lesions and duct-dependent systemic flow: single-center experience

Michał Buczyński
1
,
Jacek Kuźma
1
,
Gwan Y. Lim
2
,
Mohamed S. Emam
2
,
Marek Rączka
3
,
Magdalena Zarlenga
4
,
Krzysztof Godlewski
5
,
Wojciech Mądry
1
,
Piotr Kaźmierczak
1
,
Karolina Szymczak
1
,
Julita Sacharczuk
1
,
Mariusz Kuśmierczyk
1

  1. Cardiothoracic and Transplantology Department, Medical University of Warsaw, Warsaw, Poland
  2. Student Scientific Club, Cardiothoracic and Transplantology Department, Medical University of Warsaw, Warsaw, Poland
  3. Department of Pediatric Cardiology, Jagiellonian University, Medical College, Krakow, Poland
  4. Department of Neonatology and Rare Diseases, Faculty of Health Sciences, Medical University of Warsaw, Warsaw, Poland
  5. Pediatric Cardiology and General Pediatrics Clinic, Medical University of Warsaw, Poland
Kardiochirurgia i Torakochirurgia Polska 2025; 22 (2): 79-87
DOI: https://doi.org/10.5114/kitp.2025.152331
Online publish date: 2025/07/07
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Introduction
Hybrid procedures encompass surgical and catheter-based interventions aimed at enhancing survival rates and provide alternative treatment options for severely ill patients.

Aim
This is a retrospective study aimed at analyzing hybrid procedures in infants with complex heart defects and duct-dependent systemic circulation at a high risk of cross-clamp circulation based on a single center’s experience.

Material and methods
We included 12 infants (7 boys, 5 girls) who were admitted to our department between 2019 and 2024 and who underwent hybrid surgery due to left-sided obstructive lesions.

Results
All neonates presented progressive heart failure and multiple organ dysfunction preceding hybrid procedures. The interventions were performed at a mean age of 8.6 days, with a mean body weight of 3.3 kg. Extracorporeal membrane oxygenation was required postoperatively in 2 patients. Early and late mortality were 8.3% and 16.6%, respectively. Interstage catheterization was performed in 7 patients requiring re-dilation of pulmonary artery bands and in 2 infants with arterial duct stent stenosis. Severe tricuspid regurgitation and progressive right ventricular dysfunction due to inadequate coronary perfusion were reported in 2 patients.

Conclusions
Hybrid procedures are alternative options for infants with complex heart defects, especially when cross-clamp circulation poses high surgical risk. Multiple reinterventions are necessary to maintain stable hemodynamic status and relieve hypoxia or cardiac compromise. Future studies should aim to refine the timing and techniques of these interventions to improve survival and quality of life.

keywords:

hybrid procedures, hypoplastic left heart syndrome, Norwood procedure
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