Surgeons and Cardiologist Working Together in Interventions in Congenital Heart Disease

Hybrid therapy is an emerging field of cardiology in which the skills of surgeons and cardiologists (both interventional and imaging experts) are co-operatively combined during a procedure to improve patient outcome. A hybrid approach is defined as a combined intervention performed in a single setting or in a planned close sequential fashion. Hybrid therapies aim to “play to the strengths and minimize the weaknesses” of the different disciplines in order to tackle lesions otherwise inaccessible without a combined procedure or with suboptimal outcomes when tackled using a single approach. Inevitably this philosophy has been used to extend the boundaries of therapy in patients at or beyond the limits of traditional surgery or transcatheter treatment for example very small infants with hypoplastic heart syndrome and patients with large and potentially inaccessible muscular ventricular defects. Hybrid therapy has the potential to reduce patient morbidity and systemic stress and can offer a bridge to definitive treatment in vulnerable patients.

In addition to the more “traditional” and accepted hybrid treatments for hypoplastic left heart syndrome, ventricular septal defect closure and intra-operative stenting a number of other techniques have been described including intra-operative valvoplasty, coarctation stenting and atrial septal defect closure.

Ideally hybrid therapy requires a dedicated operating facility although many procedures can be adequately performed in ordinary catheter laboratories or operating suites with relatively minor modifications.

Given that the majority of hybrid techniques are novel the precise indications and limitations of procedures require further definition.

Keywords: Congenital heart disease, hybrid procedure, surgical procedures, devices, hypoplastic heart syndrome, pulmonary branch stenosis, tetralogy of Fallot, ventricular septal defect, atrial septostomy, valvoplasty.