Children’s National HLHS Hybrid Program
Life-Saving Treatment for the Tiniest Babies
Our program uses the hybrid procedure, which is a combination of surgery and cardiac catheterization, for babies who are too sick to go through open-heart surgery or too small for typical treatments. The goal is to help delay more complex procedures until your baby grows stronger and healthier.
The HLHS Hybrid Program offers heart surgery for high-risk newborns with hypoplastic left heart syndrome (HLHS) shortly after their birth, with a goal of minimizing complications and improving your child’s quality of life.
Our program uses the hybrid procedure, which is a combination of surgery and cardiac catherization, for babies who are too sick to go through open-heart surgery or too small for typical treatments. The goal of the hybrid procedure is to help to delay more complex procedures until your baby grows stronger and healthier.
The hybrid procedure can be performed within the first few days of life. The surgery consists of reducing the blood flow to both lungs using mini-bands around the lung vessels and implanting a special metal stent into the arterial duct to maintain sufficient blood flow to the organs. This approach eliminates the need of the heart-lung machine and a major surgical operation for vulnerable newborns.
HLHS is a congenital birth defect that affects the normal blood flow through your child’s heart. Your child’s heart has two sides, and each side has two chambers. In HLHS, the larger chamber on the left side of the heart cannot pump oxygen-rich blood to your child’s body properly, which can cause breathing problems, a weak pulse and a bluish skin color. The stronger chamber can support moving blood to the lungs and the rest of the body for a short time, however the extra work that the heart is doing will eventually cause the heart to fail.
Choosing Children’s National for Surgery for Hypoplastic Left Heart Syndrome
Our HLHS Hybrid Program can provide you with a diagnosis; unique, lifesaving treatment; and the support that you and your baby need.
- A one-of-a-kind program. We are one of the very few hybrid programs that offer minimally invasive approaches for the tiniest high-risk babies. Our program is equipped to pinpoint your child’s exact condition and tailor a personalized treatment plan for your child based on his or her risk factors. Our goal is to minimize your child’s overall risk by making sure they are strong as possible before they need to undergo open-heart surgery to correct their heart condition.
- Surgical expertise. Can Yerebakan, M.D., founder of the Children’s National HLHS Hybrid Program, is internationally recognized for his contributions to the field of congenital cardiac surgery and for helping to restore structure and function for end-stage heart failure in children. Dr. Yerebakan specializes in the hybrid treatment of hypoplastic left heart syndrome (HLHS), performing the first hybrid procedure at Children’s National in December 2017. Meet the HLHS Hybrid Program team.
- Pioneering research. We are actively developing newer and safer ways to perform cardiac procedures on young patients, with some of the world’s leading experts in cardiac catheterization and imaging. Joshua Kanter, M.D., director of Interventional Cardiology, specializes in diagnostic and interventional pediatric cardiac catheterization for the treatment of congenital heart disease. Dr. Kanter has extensive experience implanting the Melody® Transcatheter Pulmonary Valve and is an expert in the device closure of atrial septal defects, ventricular septal defects, and patent ductus arteriosus.
- Innovative technology. At Children’s National, we don’t just use advanced techniques and devices. We are actively involved in identifying and developing the next generation of procedures and technology, such as tiny pacemakers for infants, that will enable the safest and most effective care of children’s hearts. In addition, we are the only program in the United States using a specifically designed ductal stent for the arterial duct for our HLHS patients.
- Comprehensive follow-up care. After your child’s heart surgery, they will be admitted to the Children’s National cardiac intensive care unit (CICU), where our expert team of heart specialists will be involved in your child’s treatment immediately. Your child will receive highly specialized care from specially trained cardiologists and advanced practice providers that will help prepare your child to transition home.
Pediatric Surgery Options for Hypoplastic Heart Syndrome
Right after your baby is born, a hybrid procedure may be needed to help increase blood flow to your child’s body and restore heart function. Hybrid procedures are lifesaving procedures for children who are too sick or small for more invasive surgeries and treatment methods.
At Children’s National there are two ways that we start to treat our hypoplastic left heart syndrome patients:
Traditionally, babies with HLHS undergo the Norwood procedure as soon as possible after birth. This is a major open-heart, reconstructive surgery using the heart and lung machine (cardiopulmonary bypass machine) for support. The procedure is important to regulate blood flow between the heart and the lungs. The Norwood procedure combines a shunt and a complex surgical intervention to the major arteries, which are the blood vessels leading to the heart. The Norwood procedure is the first surgery that babies with HLHS undergo. Over the first few years of your child’s life, they will need more surgeries to continue to address this heart condition as they grow.
When your child is too fragile for open heart surgery, for example if they are born prematurely and aren’t yet strong enough to undergo a major cardiac surgery, our team of experts may perform a hybrid stent procedure. The hybrid stent procedure does not require open heart surgery right away. Instead, a cardiac surgeon and interventional cardiologist work together in the operating room using minimally invasive surgery. With a catheter, the team places a tiny stent, or flexible mesh tube, into your baby’s ductus arteriosus to hold it open. The ductus is an artery that carries blood and oxygen to the heart in utero. This artery typically closes after birth. By holding it open with a stent, we can keep more blood and oxygen flowing to the heart and delay the need for the Norwood procedure to begin correcting their HLHS until the baby is bigger and stronger. On average, a hybrid procedure can delay the Norwood procedure until your baby is about four to six months old.
A Hypoplastic Left Heart Syndrome Miracle
Ashley Vela Mercedes was born premature with medical issues including critical HLHS, which made her unlikely to survive. The Velas cardiologist reached out to our team of experts who were able to perform the lifesaving hybrid procedure.
For questions about the HLHS Hybrid Program or to schedule an in-person appointment or telehealth visit, please call 202-476-2811.
HLHS Hybrid Program Team
Division Chief, Cardiac Surgery Co-Director, Children's National Heart Institute
Associate Chief, Cardiac Surgery
Director, HLHS Hybrid Program
Director, Cardiovascular Surgery Fellowship Program
Medical Director, Prenatal Cardiology Program
Co-Director, Cardiac Neurodevelopmental Outcome Program
Advanced Imaging Cardiologist
Adult Congenital Cardiologist
Medical Director, Interventional Cardiology
Division Chief, Cardiac Critical Care Medicine
Executive Director, Telemedicine
Co-Director, Children's National Heart Institute
Cardiac Critical Care Specialist