Comparison of Hybrid and Norwood Strategies in Hypoplastic Left Heart Syndrome

Current surgical palliation for neonates with single ventricle physiology includes Norwood-based and Hybrid-based surgical strategies. When transplantation is not available, clinicians must choose between these two strategies with distinctly different learning curves and risk profiles. The Norwood strategy has evolved over several decades while the rising popularity of the Hybrid strategy is a much more recent addition to our therapeutic options. Based upon the premise that avoiding cardio pulmonary bypass in the neonatal period and deferral of aortic arch reconstruction until a second stage procedure have an important influence on outcomes, the Hybrid strategy has compelling theoretical advantages and disadvantages in comparison to the Norwood strategy. The purpose of this review is to summarise the currently available data to support – or refute – the theoretical advantages of the Hybrid strategy within the context of the Norwood strategy.