Off pump palliation for hypoplastic left heart syndrome: Surgical approach

The ongoing effort to improve the outcomes of patients with hypoplastic left heart syndrome and the awareness about their neurologic function has prompted consideration for a palliative strategy that does not subject these neonates to a major intervention associated with the use of cardiopulmonary bypass with or without a period of circulatory arrest. Ductal stenting and pulmonary artery banding, initially reported over a decade ago, offers an alternative form of initial palliation with minimal intervention during the newborn period while keeping all treatment options available. We describe some of the recent experiences and discuss indications, results, and issues to be addressed to further this approach.