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Case Reports

Bailout After Failed Biventricular Management of Critical Aortic Stenosis: Another Application of the Hybrid Approach

Nemours Cardiac Center at the Alfred I. duPont Hospital for Children, Wilmington, Delaware

Accepted for publication February 3, 2009.

^_* Address correspondence to Dr Pizarro, Alfred I. duPont Hospital for Children, PO Box 269, 1600 Rockland Rd, Wilmington, DE 19899 (Email: cpizarro{at}nemours.org).

The decision between a single-ventricle and biventricular strategy can be particularly difficult in patients with critical left ventricular outflow obstruction who have marginal left ventricular size or function. Overzealous pursuit of a biventricular strategy in borderline cases can lead to death or require conversion to a single-ventricle physiology at increased risk. We describe novel use of the hybrid approach as a bailout option for a patient with critical aortic stenosis who, despite balloon valvuloplasty, exhibited persistent severe left ventricular dysfunction. This approach provides a simple and effective pathway to treat patients with a failed biventricular circulation, at a considerably lower risk, while keeping all therapeutic options open.