The Brazilian Hybrid Approach for Hypoplastic Left Heart Syndrome

Until the adoption of the hybrid approach, the management of neonates with hypoplastic left heart syndrome (HLHS) had always been frustrating in our hands. The classical Norwood or the Norwood-Sano operation had had prohibitive in-hospital mortality rates. Therefore, when the concept and the technique of the hybrid approach were introduced to our group in the mid-2000s by Drs. Cheatham, Galantowicz [1], and Schranz [2], the decision to embark on this strategy was made on necessity grounds. Nevertheless, our initial results with stage I were disappointing [3], which prompted the writing of two editorials [4, 5] in a scientific journal addressing the need to improve the whole infrastructure surrounding this procedure. Our learning curve was somewhat slow in the first 5 years due to a myriad of reasons including cultural resistance to changes, lack of trained human resources (both in the medical and nursing fields), use of limited X-ray equipment (C-arm), unavailability of a dedicated hybrid room, inappropriate follow-up, among others. Since our first case done in January 2005, our technique and, more importantly, the peri-operatory and interstage care evolved significantly resulting in better and reasonable in-hospital and follow-up outcomes. This chapter reports our current results with this approach emphasizing the modifications that occurred over years of practice and probably had a beneficial effect on overall results.