Hybrid Subxiphoid Perventricular Approach as an Alternative Access in Neonates and Small Children Undergoing Complex Con
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ORIGINAL ARTICLE
Hybrid Subxiphoid Perventricular Approach as an Alternative Access in Neonates and Small Children Undergoing Complex Congenital Heart Interventions Li Yen Ng1 · Khalid Al‑Alawi1 · Colm Breatnach1 · Lars Nolke1 · Mark Redmond1 · Brian McCrossan2 · Paul Oslizlok1 · Kevin P. Walsh1 · Jonathan McGuinness1 · Damien Kenny1 Received: 27 July 2020 / Accepted: 17 November 2020 © Springer Science+Business Media, LLC, part of Springer Nature 2020
Abstract The hybrid subxiphoid perventricular approach provides direct access through the heart and may alleviate the technical limitations of complex percutaneous interventions particularly in infants with low body weight. We present the outcomes from a tertiary cardiology center using this approach. We performed a retrospective review of all patients less than 15 kg who underwent a hybrid perventricular approach via a small subxiphoid incision. Medical records were reviewed to obtain clinical, demographic and outcome data. Seventeen patients underwent 18 hybrid perventricular procedures using a subxiphoid approach. Median age at time of procedure was 4.6 months (IQR = 1.6 to 18 months) and median weight was 6.2 kgs (IQR = 3.4 to 8.6 kgs). Six patients underwent hybrid pulmonary valve replacement (PVR), 5 patients underwent pulmonary outflow stenting, and 5 infants underwent hybrid ventricular septal defect (VSD) device closure. One patient with a single ventricle who did not tolerate a percutaneous approach underwent left pulmonary artery (LPA) stenting for severe LPA coarctation with subsequent right ventricular outflow tract (RVOT) stenting. One further patient underwent implantation of a larger diameter stent for pulmonary artery bifurcation stenosis. Procedure success rate was 89% with two of the VSD cases reverted to open surgical repair. There were no intra-procedural complications; however, one patient died within 72 h. Minor adverse events occurred in 2 patients including a wound infection in one patient with an immunodeficiency syndrome. Hybrid subxiphoid perventricular approach provides an excellent alternative access to the heart especially in low birth weight infants to prevent hemodynamic instability or in small children requiring large delivery sheaths. Keywords Hybrid subxiphoid perventricular approach · Congenital heart disease · Complex cardiac catheterization · Low weight infant
Introduction Standard options for access to the heart to facilitate congenital cardiac interventions have been outstripped by the growing need for more complex interventions in smaller infants. The morbidity and mortality rate in these patients is not insignificant [1] and alternative methods to mitigate the hemodynamic instability precipitated by stiff wires
* Li Yen Ng [email protected] 1
Children Health Ireland at Crumlin, Dublin, Ireland
Royal Belfast Hospital for Sick Children, Belfast, Northern Ireland
2
and larger sheaths in hemodynamically vulnerable infants require evaluation. The hybrid perventricular approach has evolved as an alternative option
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