Hybrid Approach: A Prospective Option for Treating Congenital Heart Defects in Pediatric Patients

Congenital heart defect (CHD), a life-threatening congenital pathology, is reported in about every one neonate among 100 live births, with severity ranged from mild to fatal. The prevalence of CHD is remarkably increasing over decades, most likely due to the evolved diagnostics and improved accessibility of healthcare worldwide. The ratio of severe CHDs, which need surgery urgently, to mild forms, which sometimes do not need surgery, is between 1:4 and 1:3. Therefore, every fourth or fifth newborn with CHD needs the immediate and effective surgical treatment. Furthermore, one out of 10 diagnoses is with multiple CHDs that requires complex surgical treatment and elevates the risk of peri- and post-operative mortality. In this review, we concern epidemiology of CHD, in particular, mostly diagnosed ventricular and atrial septal defects, and patent ductus arteriosus. Next, we focus solely on ventricular septal defects (VSD). We briefly discuss the historical background and current strategies for VSD treatment – open heart surgery, transcatheter surgery, and a mini-invasive hybrid surgery. The hybrid method is then comprehensively discussed including its success and complications rate compared to other two approaches, its implementation, typical delivery approaches, and most common occluder device types; we accompany with our own clinical experience. The advantages and limitations of the hybrid surgery are also highlighted in detail. We summarize that because CHDs need treating with mini-invasive, safe, and effective approach the perspectives for wider using of hybrid surgery are well prominent, especially due to its freedom from cardiopulmonary bypass – the cornerstone of open-heart surgery.