Cardiology in the Young

Original Articles

The hybrid procedure for the borderline left ventricle

Christopher K. Davisa1a3 c1, Peter Pastuszkoa2a3, John Lambertia2a3, John Moorea1a3, Frank Hanleya4 and Howaida El Saida1a3

a1 Division of Cardiology, University of California, San Diego, California, United States of America

a2 Division of Cardiovascular Surgery, University of California, San Diego, California, United States of America

a3 Rady Children’s Hospital San Diego, University of California, San Diego, California, United States of America

a4 Division of Cardiothoracic Surgery, Lucile Packard Children’s Hospital, Stanford University, San Diego, California, United States of America


Introduction In patients with varying degrees of left heart hypoplasia, it is often difficult to determine whether the left heart structures are adequate in size to support biventricular circulation. Historically, the decision to pursue a single ventricle or biventricular repair needed to be made early and was often irreversible. The hybrid procedure may be a better initial approach for patients with borderline left ventricles.

Methods We describe a series of four patients with various congenital cardiac malformations, all of whom had borderline left ventricles. Based on pre-operative echocardiograms, several scoring systems and left ventricle volumes were used to predict the optimal type of repair. A left ventricular volume of 20 millilitres per square metre was used as the minimum cut-off value for adequacy of biventricular repair.

Results The left ventricular volumes for the patients were 17.1, 23.7, 25.4, and 25.8 millilitres per square metre. In none of the four patients were the calculations unanimous in the recommendation to pursue either type of repair. All patients underwent the hybrid procedure and then eventual single ventricle palliation (two patients) or biventricular repair (two patients). All survived with a mean follow-up of 18 plus or minus 3.9 months.

Conclusions The hybrid procedure may be the best option in patients with a borderline left ventricle. It can serve as a bridge to a more definitive repair when patients are older, larger, and for whom the decision between single ventricle and biventricular repair can be more easily made.

(Received October 21 2009)

(Accepted August 21 2010)

(Online publication November 12 2010)


c1 Correspondence to: C. K. Davis, MD, PhD, 3020 Children’s Way MC5004, San Diego, California 92122, United States of America. Tel: 858 966 5855; Fax: 858 571 7903; E-mail:

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