Although the procedure is done through an incision in the chest (sternotomy), it is hybrid in that it is performed jointly by a pediatric cardiac surgeon and a
pediatric cardiologist. It includes placement of a stent through the main pulmonary artery and placement of bands around the pulmonary arteries to prevent
overflow of blood into the lungs. The mortality rate associated with hybrid treatment of HLHS compares favorably with that of the Norwood procedure.
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The field of pediatric heart surgery has made dramatic advances in recent years, with
many serious conditions no longer carrying the grim prognoses they once did. Yet the
field remains one of the most demanding surgical disciplines. In the challenging area of
heart defect repair, hybrid treatments—which combine conventional surgery with
catheter-based procedures—now offer important alternatives.
Emile Bacha, MD, Director, Congenital
and Pediatric Cardiac Surgery
Hybrid Stage 1 Procedure for HLHS
Developed in Germany, the hybrid stage 1 procedure for HLHS provides a safer and less invasive alternative to the Norwood procedure. According to Dr. Bacha,
"During the hybrid procedure, we do not use the heart-lung machine. The procedure is pared down as much as possible in order to protect the baby at
this vulnerable age, enabling the baby to survive and become stronger. When he or she is six months old, an age when a baby is in much better shape to handle
major surgery, we correct the remainder of the problem."
Although surgical outcomes are comparable between the Norwood and hybrid procedures, the hybrid procedure is safer in that it avoids cardiopulmonary bypass
(use of the heart-lung machine to temporarily clear blood from the heart). Cardiopulmonary bypass is associated with increased neurologic risks
including attention deficit disorder, stroke, and reduced IQ. "The ability to avoid the heart-lung machine and its associated neurologic effects is an enormous
advantage to these children," says Dr. Bacha.
Hybrid Procedures in Pediatric Cardiac Surgery
When he brought the technique to the U.S. in 2003, Dr. Bacha was one of just two surgeons performing hybrid operations in children in North America. Since
then, he has not only established hybrid surgery as an important therapeutic option, but helped to improve and expand applications of hybrid techniques as well.
One such application is closing ventricular septal defects, or holes in the heart tissue. According to Dr. Bacha, "Typically, holes in the heart can be closed by
suturing a patch on the hole during open heart surgery. But certain holes are difficult to access with open heart surgery, or there may be multiple holes that
cannot be closed in one session, so that the child might need multiple open heart surgeries. In cases like these, the hybrid procedure can be very helpful. We
are able to go through the chest and deliver a device to close such holes and prevent the need for repeat surgeries. Outcomes are excellent."
At this time, MSCHONY/Columbia is one of just a few U.S. centers to offer hybrid heart operations to infants and children. The hospital is building a hybrid
pediatric catheterization laboratory and is planning a hybrid operation room, so that more children will be able to benefit from minimally invasive heart surgery.
Refining the Use of Pediatric Cardiac Hybrid Procedures at Columbia
Dr. Bacha performs hybrid heart procedures with an interventional cardiologist and in collaboration with the pediatric cardiology team at NewYork-Presbyterian
Morgan Stanley Children's Hospital/Columbia (MSCHONY/Columbia). Hybrid techniques are not applied universally, and they are not appropriate for every child.
"In the case of HLHS, there are some children who do better with the Norwood procedure than with the hybrid operation," says Dr. Bacha. "It is important to
discern which is best for each child."
Emile Bacha, MD, Director, Congenital and Pediatric Cardiac Surgery, NewYork-Presbyterian Morgan Stanley
Children's Hospital/Columbia University Medical Center, specializes in hybrid heart surgery in children. In 2003, Dr.
Bacha and others introduced a new hybrid procedure for the difficult-to-treat defect known as hypoplastic left heart
syndrome (HLHS). Children born with HLHS must undergo surgery within the first week of their lives to survive, and
until recently, the only treatment required a difficult open-chest operation followed by two additional procedures. That
standard open operation, called the Norwood procedure, carries a 10% or greater risk of death.