Hybrid approach for pulmonary atresia with intact ventricular septum: early single center results and comparison to the standard surgical approach

Catheter Cardiovasc Interv. 2014 Apr 1;83(5):753-61. doi: 10.1002/ccd.25181. Epub 2014 Jan 8.


Objectives: To examine acute and mid-term patient outcomes following the hybrid approach to pulmonary atresia with intact ventricular septum (PA-IVS) compared with the standard surgical approach.

Background: A subset of PA-IVS patients with the prospect of biventricular circulation typically undergo surgical or transcatheter right ventricular (RV) outflow tract opening. A recently described hybrid procedure, involving perventricular pulmonary valve perforation, was shown to be safe and effective in single-center series.

Methods: A single-center retrospective review of all patient with PA-IVS who underwent either surgical or hybrid RV decompression between January 2002 and December 2011 was completed and acute and mid-term patient outcomes were compared between the surgical and hybrid cohorts. Additionally, a systematic literature review was completed to compare a transcatheter cohort to the hybrid cohort.

Results: Seven patients with PA-IVS underwent a hybrid procedure; the procedure was technically successful in all attempts, and none required CPB. No patients required surgical re-intervention prior to hospital discharge, and none died during the study period. Surgical RV decompression was performed in 17 patients with a median CPB time of 80 min. Patient outcomes were nearly identical between cohorts. By systematic review, the transcatheter approach has a procedural success of 75-95% but up to 75% of patients require operation in the neonatal period.

Conclusions: The hybrid approach is a safe and feasible alternative to the standard surgical and transcatheter approaches to PA-IVS. Acute and mid-term patient outcomes are comparable with those treated with a standard surgical approach and neonatal CPB is completely avoided.

Keywords: congenital heart defect; hybrid cardiac surgery; patient outcome assessment; pediatric interventions; perventricular procedure.

Publication types

  • Comparative Study
  • Review
  • Systematic Review

MeSH terms

  • Cardiac Catheterization* / adverse effects
  • Cardiac Surgical Procedures* / adverse effects
  • Cardiopulmonary Bypass
  • Decompression, Surgical* / adverse effects
  • Female
  • Heart Defects, Congenital / diagnosis
  • Heart Defects, Congenital / physiopathology
  • Heart Defects, Congenital / surgery
  • Heart Defects, Congenital / therapy*
  • Humans
  • Infant, Newborn
  • Male
  • Michigan
  • Pulmonary Atresia / diagnosis
  • Pulmonary Atresia / physiopathology
  • Pulmonary Atresia / surgery
  • Pulmonary Atresia / therapy*
  • Retrospective Studies
  • Time Factors
  • Treatment Outcome

Supplementary concepts

  • Pulmonary Atresia with Intact Ventricular Septum