New therapy may replace heart surgery in newborns
The new technique was developed for infants with hypoplastic left heart syndrome (HLHS). In this birth defect, the left side of the heart, including the main pumping chamber and body's largest artery, is severely underdeveloped. Accounting for about 7 to 9 percent of all congenital heart defects, HLHS is fatal without rapid intervention.
Open-heart surgery is typically performed in the first few days of life and usually involves three separate surgeries, the first being the most complicated. Called the Norwood procedure, this procedure has a mortality rate of about 20 percent.
Hoping to increase the rate of survival, a team of physicians led by Emile Bacha, M.D., surgical director of the Congenital Heart Center at the University of Chicago, developed a hybrid approach.
Their approach replaces the Norwood operation with a catheter-based procedure. Instead of placing the infant on a heart-lung machine, surgeons open the chest briefly to gain access to the heart and pulmonary arteries, which travel from the heart to the lungs. Through the small opening, they place bands around the pulmonary arteries to narrow them and restrict blood flow to the heart. This raises the blood pressure in the right side of the heart.
Next, they place a stent that allows blood pumped by the right side of the heart to flow into the aorta and out to the tissues and organs of the body. This procedure allows the infant to strengthen before physicians perform the second and third open-heart surgeries to correct the underlying defects.
"Initially, we were only doing hybrids on high-risk patients and using the standard method for low-risk cases," said Dr. Bacha. "But the hybrid technique has proved so successful that it has replaced the traditional method for use with newborns at the University of Chicago Children's Hospital. Using our new hybrid technique, we have a better chance of achieving our goal of having a child who can live a normal, active life following these three procedures."
The University of Chicago is one of only a few hospitals using this technique to treat HLHS. The technique was presented Oct. 14 at the American Medical Association's 23rd Annual Science Reporters Conference in Washington, D.C.
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