Understanding the Hybrid Stage I Approach for Hypoplastic Left Heart Syndrome

Activity Summary

Hybrid stage I palliation combines cardiothoracic surgery and interventional transcatheter procedures for treatment of hypoplastic left heart syndrome. The approach is an alternative to the Norwood procedure, the traditional first stage of surgical palliation. Hybrid stage I palliation involves placing bilateral branch pulmonary artery bands and a patent ductus arteriosus stent through a median sternotomy, performed without cardiopulmonary bypass. The purpose of the bands is to control blood flow to the lungs and protect the pulmonary bed while the stent sustains systemic cardiac output. A balloon atrial septostomy is performed to create an atrial septal defect for unobstructed blood flow from the left atrium to the right atrium. The second stage of palliative surgery is the comprehensive stage II, which incorporates removal of the stent and pulmonary artery bands, atrial septectomy, anastomosis of the diminutive ascending aorta to the main pulmonary artery, aortic arch augmentation, and bidirectional cavopulmonary anastomosis. The traditional Fontan procedure completes the series of palliation.

Objectives

Identify the surgical and interventional techniques that comprise the hybrid stage 1 procedure.
List the advantages of the hybrid stage I procedure.
Describe monitoring required of HLHS infants during the interstage period.

Continuing Education Disclosure Statement

Successful Completion

Learners must attend/view/read the entire activity and complete the associated evaluation to be awarded the contact hours or CERP. No partial credit will be awarded.

Disclosure

This activity has been reviewed by the Nurse Planner. It has been determined that the material presented here shows no bias. Approval of a continuing education activity does not imply endorsement by AACN or ANCC of any commercial products displayed or discussed in conjunction with the activity.

Accreditation

The American Association of Critical-Care Nurses (AACN) is accredited with distinction as a provider of continuing nursing education by the American Nurses Credentialing Center’s (ANCC's) Commission on Accreditation, ANCC Provider Number 0012 (60 min contact hour). AACN has been approved as a provider of continuing education in nursing by the California State Board of Registered Nursing, California Provider number CEP1036 contact hours (50 min contact hour).

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