A unified approach to congenital heart intervention and surgery to reduce trauma

Chief, Cardiac Surgery Division, Miami Children's Hospital, Cardiac Program, Miami, Florida, USA
Redmond P. Burke

A supportive relationship between interventional cardiologists and congenital heart surgeons may accelerate the development of less traumatic therapy for congenital heart disease. Each patient presented to the cardiac program is assessed with the goal of providing the least traumatic form of therapy for each lesion over the child's lifetime. General options include, transcatheter procedures, minimally invasive surgery, hybrid procedures using both forms of therapy, and finally, conventional surgery. To minimize the trauma of using transcatheter techniques in our center, surgical backup is provided so that patients found in the catheterization laboratory to be unsuitable for device closure can be immediately converted to a minimally invasive surgical approach, sparing the child a second anesthetic, and the family the stress of a failed intervention.
Hybrid procedures are evolving video-assisted cardioscopy has been used to guide placement of transcatheter septal occlusion devices. Transcatheter closure of extra-cardiac Fontan fenestrations and emergent placements of transcatheter stents for occluded shunts have been performed in the catheterization laboratory with surgical support. This support can include vascular access, direct trans-cardiac access, and planned or emergent cardiopulmonary support. Hybrid repair of pulmonary artery pseudoaneurysm with endovascular stent grafting was recently described. Hybrid techniques may ultimately produce the most effective strategies for managing complex pulmonary artery stenoses. In the operating room, surgical exposure can be used to facilitate transcatheter stent placement. The ultimate environment to maximize the potential of this approach will be a multidisciplinary intervention/surgery/diagnostic theatre incorporating all existing therapeutic technology into a single procedure suite.