Applying the Hybrid Concept as a Bridge to Transplantation in Infants Without Hypoplastic Left Heart Syndrome

Area of Science:

• Pediatric Cardiology
• Congenital Heart Disease
• Cardiac Surgery

Background:

• Limited therapeutic options exist for infants with decompensated heart failure unresponsive to medical management.
• The hybrid procedure, typically for single ventricle physiology, is explored for biventricular failure.
• This approach aims to stabilize critically ill infants awaiting heart transplantation.

Purpose of the Study:

• To evaluate the efficacy of the hybrid procedure as a bridge to transplantation in infants with biventricular failure.
• To assess outcomes in neonates without single ventricle congenital heart disease undergoing this intervention.

Main Methods:

• Retrospective analysis of eight infants with biventricular failure treated with the hybrid procedure between 2008 and 2021.
• Patients were critically ill, with a median weight of 3.2 kg, median age of 18 days, and high rates of mechanical ventilation and inotropic support.
• The hybrid procedure aims to secure systemic circulation, reduce left atrial pressure, and protect pulmonary vasculature.

Main Results:

• All eight patients experienced positive outcomes, either improving sufficiently to be delisted or undergoing successful transplantation.
• The median time from the hybrid procedure to transplantation was 63 days.
• The hybrid procedure effectively supported systemic circulation and relieved pulmonary hypertension in this cohort.

Conclusions:

• The hybrid procedure is a viable and effective therapeutic bridge to heart transplantation for select infants with biventricular failure and no single ventricle congenital heart disease.
• This approach offers a potentially lower-risk alternative to other therapies for critically ill neonates.
• Careful patient selection is crucial for successful outcomes using the hybrid procedure.