At the Nationwide Children's Heart Center, we have pioneered the concept of the Hybrid approach to complex congenital heart disease. A Hybrid case is one that combines the talents of a cardiac surgeon and an interventional cardiologist.

An example is our new Hybrid approach for the initial palliation for Hypoplastic Left Heart Syndrome. The traditional approach (The Norwood Procedure) involves an extensive open heart procedure which creates a neoaorta, disconnects the pulmonary arteries and provides pulmonary blood fl ow by a Gore-Tex® shunt which provides adequate pulmonary fl ow while protecting against overcirculation. Cardiopulmonary bypass and circulatory arrest are typically required. In contrast, our Hybrid approach protects against pulmonary overcirculation by banding the pulmonary arteries individually through a limited incision in the chest without cardiopulmonary bypass. The cardiac surgeon then provides access to the patent ductus through the proximal pulmonary artery, allowing the interventional cardiologist to place a stent in the ductus arteriosus, thus keeping it open, serving as the conduit to the aorta. Just prior to discharge, a transcatheter balloon atrial septostomy is performed, allowing unobstructed fl ow for the left side to the right side of the heart. The same objectives are obtained as the Norwood Procedure, but with the Hybrid approach there is no bypass involved, and no circulatory arrest. Therefore, the procedure can be performed without blood, which in part explains our international reputation among parents of the Jehovah's Witness faith.

Avoiding open heart surgery and circulatory arrest in the newborn period has several theoretical long-term advantages, both in terms of mortality and morbidity as well as long-term neurologic outcome. The effect on overall outcomes for Stage I palliation at the Heart Center has been remarkable. In the most recent year, 13 Stage I palliations were carried out, 11 by Hybrid approach and two with a traditional Norwood Procedure without a mortality. These results are excellent by both national and regional standards.

This type of innovative approach requires a new look at space and equipment. Traditional cardiac catheterization laboratories are not designed to be operating rooms. The cath tables provide best access to the patient from the groin area and have maximum flexibility for the table and biplane imaging equipment. Access to the chest is limited and there is not space and support for cardiopulmonary bypass equipment. Operating rooms, on the other hand, are set up for bypass, maximum access to the chest, and plenty of room for anesthesia and diagnostic equipment, but have only rudimentary imaging equipment. The two Hybrid Suites in The Heart Center have been specifically designed with both needs in mind. Built to Operating Room standards, all necessary space and access exist for an open heart surgical team. At the same time, state-of-the-art imaging and physiologic equipment gives the interventional cardiologist the necessary tools to perform the intervention. Our two Hybrid Cardiac Catheterization Suites opened in 2004 and were the first in the world specifically designed for Hybrid procedures.

Interventional and surgical teams from all over the country visit our Hybrid Suites to learn more about Hybrid therapies and room design. In addition, we have had visitors from Europe, South America, and Asia visit our team of specialists.

Hybrid Stage 1 palliation has been performed successfully by our team in babies as small as 1.1 kg... not much larger than your hand.


After pulmonary artery bands have been placed, a self-expandable PDA stent is implanted off cardio-pulmonary bypass. An angiogram confirms excellent placement of the stent and PA bands. A follow up 3D MSCT scan is performed prior to Comprehensive Stage II repair and nicely demonstrates the PA bands, PDA stent, and atretic ascending aorta.

It is common for visitors from other countries to visit our Hybrid Cardiac Catheterization Suites. Guests from FuWai Cardiovascular Hospital in Beijing, China observe a Hybrid Stage I palliation for HLHS by our team.



Hybrid Stage 1 palliation has been performed successfully by our team in babies as small as 1.1 kg... not much larger than your hand.



First-of-a-kind Hybrid Suite and Table






During a Hybrid procedure for intraoperative delivery of an LPA stent on cardio-pulmonary bypass, endoscopic imaging confirms appropriate placement of the stent proximal to the upper and lower lobe branches.