Achieving a balance in the current approach to the surgical treatment of hypoplastic left heart syndrome

Abstract

In this Supplement, and at its associated Symposium “Controversies of Hypoplastic Left Heart Syndrome”, various contributors presented a variety of topics regarding “state of the art” treatments for hypoplastic left heart syndrome. The extent of the differences within these various presentations attests to the very significant challenges that remain in optimizing care of these patients, and related ones with other types of functionally univentricular hearts. Of these challenges, the initial surgical approach, be it staged palliation or cardiac transplantation, has been a hotly debated issue, with diametrically opposed schools of thought.1Today, with further experience, technical advances, and dramatically improved outcomes, there seems to be an emerging complimentary role for both options, favoring a staged reconstructive approach in the majority of circumstances. We review here the salient issues that have lead to this position, and discuss strategies for maintaining a program offering both staged palliation and transplantation for patients with hypoplasia of the left heart.