Pitfalls in hybrid procedures in newborns with left-sided obstructive lesions and duct-dependent systemic flow: single-center experience.

Introduction: Hybrid procedures encompass surgical and catheter-based interventions aimed at enhancing survival rates and provide alternative treatment options for severely ill patients. Aim: This is a retrospective study aimed at analyzing hybrid procedures in infants with complex heart defects and duct-dependent systemic circulation at a high risk of cross-clamp circulation based on a single center's experience. Material and methods: We included 12 infants (7 boys, 5 girls) who were admitted to our department between 2019 and 2024 and who underwent hybrid surgery due to left-sided obstructive lesions. Results: All neonates presented progressive heart failure and multiple organ dysfunction preceding hybrid procedures. The interventions were performed at a mean age of 8.6 days, with a mean body weight of 3.3 kg. Extracorporeal membrane oxygenation was required postoperatively in 2 patients. Early and late mortality were 8.3% and 16.6%, respectively. Interstage catheterization was performed in 7 patients requiring re-dilation of pulmonary artery bands and in 2 infants with arterial duct stent stenosis. Severe tricuspid regurgitation and progressive right ventricular dysfunction due to inadequate coronary perfusion were reported in 2 patients. Conclusions: Hybrid procedures are alternative options for infants with complex heart defects, especially when cross-clamp circulation poses high surgical risk. Multiple reinterventions are necessary to maintain stable hemodynamic status and relieve hypoxia or cardiac compromise. Future studies should aim to refine the timing and techniques of these interventions to improve survival and quality of life.