Key result
A non-surgical transcatheter stage-I approach using pulmonary flow restrictors and ductal stenting is proposed as an alternative to Norwood or Hybrid procedures for hypoplastic left heart syndrome.
Why the study?
To explore an alternative percutaneous transcatheter technique for a completely non-surgical stage-I approach to avoid complex neonatal heart operations and intensive care in hypoplastic left heart syndrome.
Does a completely percutaneous transcatheter stage-I approach (DIDI) provide an effective alternative to Norwood or Hybrid surgery in newborns with hypoplastic left heart syndrome?
Does a completely percutaneous transcatheter stage-I approach (DIDI) provide an effective alternative to Norwood or Hybrid surgery in newborns with hypoplastic left heart syndrome?
A completely percutaneous transcatheter stage-I palliation using pulmonary flow restrictors and ductal stenting is technically feasible and may soon offer a non-surgical alternative to Norwood or Hybrid approaches for newborns with hypoplastic left heart syndrome.
The hypoplasia of left-sided heart structures shows great variability and complexity. What the many variants have in common is that their heart structures are neither fully developed before nor after birth. Fetuses and newborns require an individual therapy depending on anatomy and function of the heart. Fetal interventions focus on improving left heart structures by catheter-based interventions and maternal hyperoxygenation which promotes growth as the left ventricular preload and blood flow within the cavity increase. Stage-I management of newborns with single ventricle physiology is usually based on the Norwood/Sano surgery or the Hybrid approach. Two more steps are required to ultimately achieve a Fontan circulation. Some centers also use the Hybrid approach for subsequent Norwood operation beyond the neonatal period. After the Hybrid approach, a comprehensive stage-II or corrective surgery is performed, the latter if a bi-ventricular circulation is possible. With progressively improved catheter-based interventions, particularly ductal stenting and manipulations of the atrial septum, the next advance is to develop a bespoke flow restrictor that can be easily inserted into the branches of the pulmonary artery. The main goal is to avoid complex heart operations under general anesthesia, followed by substantial intensive care in the neonatal period, especially for patients with complex heart defects. Based on the current state of the art of surgical treatment of hypoplastic left heart syndrome and variants with the Norwood surgery or the Hybrid approach, our main focus is on an alternative percutaneous transcatheter technique in the sense of a completely non-surgical stage-I approach.
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Schranz et al. (2021) conducted a review in Hypoplastic left heart syndrome. Percutaneous transcatheter stage-I palliation vs. Norwood surgery or Hybrid approach was evaluated. A non-surgical transcatheter stage-I approach using pulmonary flow restrictors and ductal stenting is proposed as an alternative to Norwood or Hybrid procedures for hypoplastic left heart syndrome.
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