Hybrid approach: a prospective option for treating congenital heart defects in pediatric patients

Congenital heart defects (CHDs), a life-threatening congenital pathology, are reported in approximately one out of every 100 live births, with the severity ranging from mild to fatal. The prevalence of CHDs has significantly increased over the last few decades, most likely due to evolved diagnostics and increased accessibility to healthcare worldwide. The ratio of severe CHDs, which require urgent surgery, to mild forms, which may not require surgery, is between 1:4 and 1:3. Therefore, every fourth or fifth newborn with a CHD needs immediate and effective surgical treatment. Furthermore, one in 10 diagnoses involves multiple CHDs, which require complex surgical treatment and elevate the risk of peri- and post-operative mortality. In this review, we focus on ventricular septal defects (VSDs) that constitute a significant proportion of CHDs. We briefly discuss the historical background and current strategies for VSD treatment, including open-heart surgery, transcatheter surgery, and mini-invasive hybrid surgery. The hybrid method is then comprehensively discussed, considering its success and complication rates compared to the other two approaches, its implementation, typical delivery approaches, and the most common types of occluders; we accompany this discussion with our own clinical experiences. The advantages and limitations of the hybrid approach are also discussed. We conclude that the prospects for wider use of the hybrid approach for VSD correction are favorable due to its mini-invasiveness, high safety and effectiveness, and because cardiopulmonary bypass is not needed in this approach.