Hybrid Procedures in the Management of Hypoplastic Left Heart Syndrome: A Systematic Review

Hybrid Procedures in the Management of Hypoplastic Left Heart Syndrome: A Systematic Review | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Systematic Review Hybrid Procedures in the Management of Hypoplastic Left Heart Syndrome: A Systematic Review Nikoloz Labartkava This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-6990296/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Background/Objectives: HLHS is considered one of the most severe congenital heart defects and occurs in approximately 2-3% of all CHD cases. Hybrid procedures have been introduced as an alternative to traditional surgical techniques, such as the Norwood procedure, particularly for neonates at high risk. Although the hybrid approaches claim to reduce surgical risks and improve recovery, little is known regarding their comparative effectiveness and safety. This review aims to describe the contribution of hybrid procedures in HLHS management regarding survival rates, postoperative complications, and quality of life through recovery outcomes and long-term results in light of conventional surgical techniques. Methods: A systematic review was carried out following the PRISMA guidelines. Data will be retrieved from PubMed, Cochrane Library, Scopus, and ClinicalTrials.gov. The search will include articles published from January 2014 to November 2024. Inclusion will be focused on pediatric patients diagnosed with HLHS and studies comparing hybrid procedures versus traditional surgical methods. All screening, data extraction, and quality assessment will be done by two independent reviewers. Results : This review analyzed data from 11 studies comprising 934 neonates with Hypoplastic Left Heart Syndrome (HLHS), with 371 undergoing hybrid procedures and 563 receiving the Norwood procedure. The findings demonstrate that both approaches achieved comparable survival rates at 1, 3, and 5 years. Hybrid procedures were linked to slightly earlier interventions (SMD = -0.10, 95% CI: -0.61 to 0.41, p = 0.77) and were favored for high-risk neonates due to reduced invasiveness. However, hybrid procedures exhibited a higher rate of interstage mortality (SMD = 0.81, 95% CI: -0.62 to 2.25, p = 0.09) and pulmonary artery stenosis requiring reinterventions (30% vs. 18% for Norwood). Norwood procedures were associated with fewer reinterventions and lower interstage mortality, highlighting their effectiveness for stable patients. Conclusions : Hybrid procedures offer a practical alternative to the Norwood procedure, especially for high-risk neonates. Although both approaches show similar long-term survival rates, hybrid procedures are associated with a higher risk of complications, including increased interstage mortality. These challenges highlight the need for continued advancements to refine hybrid techniques and improve long-term outcomes. This review emphasizes the critical role of tailored patient selection and calls for further research to enhance hybrid procedure protocols and optimize their effectiveness for specific patient populations. Hypoplastic Left Heart Syndrome Hybrid procedures Norwood procedure systematic review pediatric cardiology Full Text Additional Declarations The authors declare no competing interests. Cite Share Download PDF Status: Posted Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-6990296","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Systematic Review","associatedPublications":[],"authors":[{"id":477328837,"identity":"6b355788-fc52-4e72-b3e5-5a857752e2ed","order_by":0,"name":"Nikoloz Labartkava","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA+UlEQVRIiWNgGAWjYBACPgYeEJUA5hxsYLBhYJAgoIUNrCUBriWNRC2MDQyHidDCfvbg58ofafIGx88ePDij5nxi/+zmgw8YamyicWrhyUuWPJOQY7jhTF7CwQ3HbifOuHMs2YDhWFpuA06H5RhINiRUMM5syDE4+IDtdmLDjRwzCcaGw7i18L8x/gnUYj+z/w1Qy79zifMJapHIMQPakpPYLwG0ZWPbgcQNhLW8S7NsSEtL7pcA2jKzL9l44420ZIMEPH7h5889fLPBJtm2jT/H+GPPNzvZeTeSDz74UGODUwsGcASrTCBWOQjYk6J4FIyCUTAKRgYAAKpdYqzy62DQAAAAAElFTkSuQmCC","orcid":"","institution":"","correspondingAuthor":true,"prefix":"","firstName":"Nikoloz","middleName":"","lastName":"Labartkava","suffix":""}],"badges":[],"createdAt":"2025-06-27 09:48:42","currentVersionCode":1,"declarations":{"humanSubjects":true,"vertebrateSubjects":false,"conflictsOfInterestStatement":false,"humanSubjectEthicalGuidelines":true,"humanSubjectConsent":true,"humanSubjectClinicalTrial":false,"humanSubjectCaseReport":false,"vertebrateSubjectEthicalGuidelines":false},"doi":"10.21203/rs.3.rs-6990296/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-6990296/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":85630412,"identity":"0ff25cc6-cd43-4090-9fc2-c1b38352345d","added_by":"auto","created_at":"2025-06-30 03:10:36","extension":"pdf","order_by":1,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":791564,"visible":true,"origin":"","legend":"","description":"","filename":"LabartkavaHybridProceduresintheManagementofHypoplasticLeftHeartSyndromeASystematicReview.pdf","url":"https://assets-eu.researchsquare.com/files/rs-6990296/v1_covered_aa551ff8-7505-4679-9813-eb61838fdb96.pdf"}],"financialInterests":"The authors declare no competing interests.","formattedTitle":"\u003cp\u003eHybrid Procedures in the Management of Hypoplastic Left Heart Syndrome: A Systematic Review\u003c/p\u003e","fulltext":[],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":false,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":true,"hideJournal":true,"highlight":"","institution":"University of Bergamo","isAcceptedByJournal":false,"isAuthorSuppliedPdf":true,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":true,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"Hypoplastic Left Heart Syndrome, Hybrid procedures, Norwood procedure, systematic review, pediatric cardiology","lastPublishedDoi":"10.21203/rs.3.rs-6990296/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-6990296/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003eBackground/Objectives: \u003c/strong\u003eHLHS is considered one of the most severe congenital heart defects and occurs in approximately 2-3% of all CHD cases. Hybrid procedures have been introduced as an alternative to traditional surgical techniques, such as the Norwood procedure, particularly for neonates at high risk. Although the hybrid approaches claim to reduce surgical risks and improve recovery, little is known regarding their comparative effectiveness and safety. This review aims to describe the contribution of hybrid procedures in HLHS management regarding survival rates, postoperative complications, and quality of life through recovery outcomes and long-term results in light of conventional surgical techniques.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMethods: \u003c/strong\u003eA systematic review was carried out following the PRISMA guidelines. Data will be retrieved from PubMed, Cochrane Library, Scopus, and ClinicalTrials.gov. The search will include articles published from January 2014 to November 2024. 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