Hybrid therapy for XXXX : Myth, alternative, or standard?

@entity1 @entity1699 @entity1146
OBJECTIVE: This retrospective study presents our operative results, mortality, and morbidity with regard to pulmonary artery growth and reinterventions on the pulmonary artery and aortic arch, including key features of our institutional standards for the 3-stage hybrid palliation of @entity1 with @entity1699 . METHODS: Between June 1998 and February 2015, 182 @entity1 with @entity1699 underwent the Giessen hybrid stage I procedure. Among these, 126 @entity1 with @entity1699 who received a univentricular palliation or heart transplantation were included in the main analysis. Median age and body weight of @entity1 at hybrid stage I were 6  days (0-237) and 3.2  kg (1.2-7), respectively. Comprehensive stage II operation was performed at 4.5  months (2.9-39.5), and Fontan completion was established at 33.7  months (21.1-108.2). Operative and interstage mortality, morbidity, growth and reinterventions on the pulmonary arteries, and long-term operative results of the aortic arch reconstruction were assessed. RESULTS: Median follow-up time after Giessen hybrid stage I palliation was 4.6  years (0-16.8). Operative mortality at hybrid stage I, comprehensive stage II, and Fontan completion was 2.5%, 4.9%, and 0%, respectively. Cumulative interstage mortality was 14.2%. At 10  years, the probability of survival is 77.8%. Body weight (<2.5  kg) and aortic @entity1146 had no significant impact on survival. McGoon ratio did not differ at comprehensive stage II and Fontan completion (P  =  .991). Freedom from pulmonary artery intervention was estimated to be 32.2% at 10  years. Aortic arch reinterventions were needed in 16.7% of @entity1 ; 2 reoperations on the aortic arch were necessary. CONCLUSIONS: In view of the early results and long-term outcome, the hybrid approach has become an alternative to the conventional strategy to treat neonates with @entity1699 and variants. Further refinements are warranted to decrease @entity1 morbidity.
