The hybrid procedure for the borderline left ventricle

Area of Science:

• Pediatric Cardiology
• Congenital Heart Disease
• Surgical Innovation

Background:

• Left heart hypoplasia presents challenges in determining suitability for biventricular circulation.
• Historically, early and irreversible decisions between single ventricle or biventricular repair were necessary.
• Borderline left ventricles complicate surgical planning for congenital cardiac malformations.

Observation:

• Four patients with borderline left ventricles underwent assessment using echocardiograms and scoring systems.
• A left ventricular volume cutoff of 20 mL/m² was used to assess adequacy for biventricular repair.
• Pre-operative assessments yielded non-unanimous recommendations for repair type in all cases.

Findings:

• All four patients with borderline left ventricles were treated with the hybrid procedure.
• Post-hybrid procedure, two patients proceeded to single ventricle palliation and two to biventricular repair.
• The hybrid procedure facilitated survival in all patients, with a mean follow-up of 18 months.

Implications:

• The hybrid procedure may be the optimal initial strategy for neonates with borderline left ventricles.
• This approach acts as a bridge, enabling more definitive surgical decisions later in life.
• Delayed decision-making allows for better patient growth and more accurate assessment of cardiac structures.