Surgeons and Cardiologist Working Together in Interventions in Congenital Heart Disease
Pp. 207-228 (22)
John D.R. Thomson and Shakeel A. Qureshi
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.
Congenital heart disease, hybrid procedure, surgical procedures,
devices, hypoplastic heart syndrome, pulmonary branch stenosis, tetralogy of
Fallot, ventricular septal defect, atrial septostomy, valvoplasty.
Department of Congenital Heart Disease, Evelina Children's Hospital, Bridge Rd, London, Greater London SE1 7EH, United Kingdom