Research Topic

The developments of hybrid surgical strategies for congenital heart disease

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Interventional cardiac catheterization has become an integral component of the management of children and adults with congenital heart disease (CHD). Progress in the application and acceptance of interventional cardiac catheterization in this setting has been swift, and the pace is quickening. Nevertheless, ...

Interventional cardiac catheterization has become an integral component of the management of children and adults with congenital heart disease (CHD). Progress in the application and acceptance of interventional cardiac catheterization in this setting has been swift, and the pace is quickening. Nevertheless, the vast majority of congenital heart conditions still require an “open” surgical intervention using cardiopulmonary bypass (CPB) and cardioplegic arrest, well-known independent risk factors for peri-operative morbidity and mortality in congenital cardiac patients undergoing cardiac surgery.
The concept of minimally invasive surgery for CHD in paediatric patients has the aim of reducing the trauma of the operation at each stage of management. In this respect, the advent of the hybrid surgical options for treating cardiac disease has integrated the techniques of interventional cardiology with the techniques of cardiac surgery to provide a form of therapy that combines the respective strengths of both fields.
Pulmonary valve replacement (PVR) is a very good example of a congenital condition where the pattern ship between interventional cardiologists and cardiac surgeons has created an environment for the development of “less invasive” hybrid surgical strategies. In the current era approximately 90% of infants born with tetralogy of Fallot (TOF) are expected to live beyond 40 years of age making it the fast growing population amongst patients with congenital heart disease. One of the most common late complications after repair of TOF, is pulmonary regurgitation. Development of percutaneous approaches to valve disease is one of the most exciting areas of research and clinical innovation in cardiovascular research. The main development has been that of transcatheter PVR for the rehabilitation of conduits between the right ventricle and pulmonary artery in patients after surgery for TOF. However, with the percutaneous technique, a limited size of prosthesis can be inserted, and the technique cannot be used in a native right ventricular outlet tract (RVOT) because it requires a conduit for adequate fixation. The development of hybrid PVR is rapidly changing this clinical scenario allowing an increasing number of patients with native RVOT to receive a pulmonary valve without the use of CPB and cardioplegic arrest. Similar progress is being made for other common congenital conditions such as ventricular and atrial septal defects, hypoplastic left heart syndrome and aortic coarctation.

This Research Topic will provide a broad overview of some of the new and exciting hybrid procedures used in the treatment of children and adults with CHD, with an emphasis on new tools that are revolutionizing the field. We will specifically focus on techniques for closing shunt lesions, valvular interventions, methods for achieving patency of vascular obstructions, and selected additional interventions applicable to some complex lesions. The aim of this Research Topic will be to provide cardiologists and surgeons involved in the treatment of CHD a broader view of how a close cooperation between interventional cardiology and cardiac surgery can potentially improve clinical outcomes in this very challenging and high risk patient population.


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