Impact of Preoperative Treatment Strategy on Hybrid Therapy

Abstract

Background: The preoperative strategy is important for successful hybrid therapy （HT）.
Purpose: To investigate the impact of the preoperative strategy on HT.
Subjects: Seven patients received HT at our hospital. The diagnosis was 1） tricuspid atresia complicated by Cantrell syndrome （1 case）, 2） pulmonary atresia （PA） with ventricular septal defect （VSD） and major aortopulmonary collateral arteries （MAPCAs） （1 case）, 3） total cavopulmonary connection （TCPC） candidates with thromboembolism of the left pulmonary artery （LPA） （4 cases）, and 4） transposition of the great arteries （TGA） with the hypoplastic right ventricle （1 case）.
Method: The procedures were 1） TCPC via lateral thoracotomy and coil embolization for a left Blalok-Taussig shunt （BTS） in the patient with Cantrell syndrome, 2） direct stenting for pulmonary stenosis that was inaccessible by catheter intervention, 3） direct stenting for LPA thromboembolism, and 4） trans-right atrial balloon atrial septostomy （BAS） via anterior thoracotomy. In all patients, we investigated the imaging data carefully and simulated treatment with all staff participating, so that everyone understood the processes and procedures.
Results: All procedures were performed successfully and less invasively. TCPC for Cantrell syndrome was done via lateral thoracotomy. A palliative Rastelli procedure could be performed for PA with VSD and MAPCAs. The TCPC candidates with thromboembolic LPA avoided the future risk of unilateral pulmonary circulation. BAS could be done safely for TGA.
Conclusion: Even if an institution does not have a Hybrid Suite, sufficient preoperative planning for HT and good teamwork among the staff can achieve successful results.