Extract

Dear Editor,

Chen et al. report on the single-centre experience with the increased use of the Hybrid procedure in newborns with hypoplastic left heart syndrome but without improvement in early survival [1]. Despite the notable contributions of the institution (CHOP) in pioneering the Norwood procedure, the rationale behind the institutional introduction and growing preference for the stage-1 Hybrid procedure (hS1P) up to 30% in recent years despite a significant decline in the total number of Norwood operations remains enigmatic. A greater clarity regarding the adoption of the Hybrid approach is obvious. The question rises if the shift towards hS1P was due to the plateaued operative mortality or based on morbidity criteria following Norwood surgeries [2]. Without the knowledge of technical details of the utilized hS1P with included periprocedural intensive care necessitates, the analysed discrepancy in both procedural outcomes cannot be retraced. Additionally, it stays open how in future the newborns with (multiple) risk factors will be treated at CHOP.

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