Hybrid and Catheter-based Surgery for Babies with Congenital Heart Defects

Approximately 30,000 children are born each year with congenital heart defects (about one percent of all live births) in the United States, and .2 to .3 of these children will require cardiac surgery. The Congenital Heart Center at NewYork-Presbyterian Morgan Stanley Children’s Hospital (NYP-MSCHONY) brings together an integrated team of specialists to provide seamless collaboration and a continuum of care for these young patients.

Treatment options are tailored to the diagnosis and presentation of symptoms for each patient and any other medical conditions that may need to be taken into consideration. Increasingly, many congenital heart defects can now be effectively treated with minimally invasive catheter-based interventions that reduce both risk and recovery duration. These treatments often require only a single day of hospitalization, and can eliminate the need for open-heart surgery. The Congenital Heart Center has particular expertise in pediatric interventional cardiology, a specialty that involves non-surgical treatment of congenital and acquired cardiovascular disorders.

Additionally, the Congenital Heart Center is also one of only a few in the U.S. to have a hybrid program for infants and children who do require surgery but could benefit from a minimally invasive surgical procedure in combination with catheter-based interventions. Hybrid heart surgery refers to techniques that combine conventional surgical procedures with minimally invasive, catheter-based interventions. These alternatives typically involve only a small incision through the breast bone or right chest, and advantages include less pain, elimination of the heart-lung machine (and its associated risks), a faster return to normal activities, as well as cosmetic advantages.

In Surgery, Less is More

According to Emile Bacha, MD, Chief of Congenital and Pediatric Cardiac Surgery, patients at the Congenital Heart Center are always evaluated for less invasive treatment options first. In some cases, a hybrid approach will allow the surgeon to treat a condition with a single operation rather than a series of surgeries, or to treat conditions that would otherwise be inoperable. Dr. Bacha explains, “As with any treatment options, hybrid techniques may not be appropriate for every child. Some babies still benefit from more traditional surgical procedures, and surgeons evaluate each patient to determine which procedure carries the best possible benefits and outcomes.”

Hybrid techniques can offer significant benefits for some patients, including infants with difficult-to-treat conditions. Surgeons at the Congenital Heart Center have been successfully using a less invasive hybrid technique for a very difficult-to-treat defect in newborns known as hypoplastic left heart syndrome (HLHS). To survive, babies born with this anomaly must undergo surgery during the first week of life, and until recently the only treatment available was the Norwood procedure, requiring three difficult standard open operations and carrying a 10-20 percent greater risk of mortality (based upon national statistics). Because infants with HLHS require treatment at a very young age, hybrid procedures can be used to provide immediate interventions and delay more invasive surgeries until infants are older and stronger.

Surgical outcomes are currently comparable between the hybrid approach and the Norwood procedure, but the hybrid approach is thought to be safer for high-risk patients such as in infants with a low birth weight or who are born prematurely, in large part by avoiding the use of a heart-lung bypass machine.

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