Biventricular repair in children with hypoplastic left heart complex

Aims: There are various surgical strategies for treatment of patients with hypoplastic left heart complex (HLHC). Duct stenting combined with bilateral pulmonary artery banding (PAB) is a new method, employed as an alternative first step approach. We describe this interventional-surgical „hybrid-approach“ as a strategy to achieve biventricular repair (BVR) in newborns with HLH-complex.

Methods: Between 1998 and April 2006, 19 newborns with HLHC underwent ductal stenting and PAB. Underlying diagnoses were Interupted aortc arch with hypoplastic aortic valve (IAA) in 6 patients, HLHS with aortic valve stenosis in 11 patients, and 2 patients with other complex left heart hypoplasia. BVR was performed 3.5 to 9.6 months later with a mean body weight of 5.6kg. Operative techniques included aortic arch reconstruction (AAR) with commisurotomie (n=8), Norwood –AAR with Rastelli (n=5), AAR and VSD closure (n=4), AAR with Ross-Konno (n=1) and subaortic resection with mitral valve repair (n=1). All operations were performed without circulatory arrest.

Results: All 19 patients survived BVR and were discharged home. One patient died suddenly late after operation. Another patient was transplanted because pulmonary hypertension developed. Another patient was switched to univentricular palliation. 16 patients did not undergo any further operation until now. Survival rate is 93%.

Discussion: The hybrid stage I palliation followed by BVR is a valid option in high-risk neonates and expands the surgical options for newborns with HLHC. Results of our center are encouraging. Especially the number of reoperations is far lower, than discussed in the literature.