Early post-operative outcomes in very young infant patients after off-pump periventricular hybrid surgery vs. on-pump traditional cardiopulmonary bypass

Background: Traditionally ventricular septal defects (VSDs) are corrected via open-heart surgery under cardiopulmonary bypass (CPB), which involves prolonged anesthesia and increases the risk of neurological complications in very young children. In the present retrospective study, we compare early post-operative outcomes of traditional CPB versus a periventricular hybrid surgery (PHS) for VSD correction in infants aged ≤1 year. Methods: The patients were divided into the PHS cohort (n=181) and the CPB cohort (n=189), treated between 2016 and 2024 at a single center. Results: The hybrid approach significantly reduced the duration of anesthesia, mechanical ventilation, intensive care unit (ICU) stay, and in-hospital stay. The post-operative left ventricular ejection fraction (LVEF) was significantly higher while its change vs. pre-operative level was significantly lower in the PHS vs. CPB cohort. Only 21% of PHS patients required inotropic support, compared to 95.8% of CPB patients. Notably, the CPB cohort exhibited a significantly higher incidence of early post-operative transient neurological disorders vs. the PHS cohort (46.0% vs. 8.3%). We identified age as well as weight, height, and body surface area as risk factors for neurological complications in both surgical cohorts, regardless the type of a neurological complication. Additionally, we revealed lowered intraoperative arterial pressure and elevated post-operative LVEF as independent risk factors. Conclusions: The hybrid VSD correction is a highly effective and safer alternative to traditional open-heart surgery for infants. It significantly minimizes early post-operative morbidities, reduces recovery times, and dramatically lowers the incidence of transient brain ischemia that can result in various neurological disorders.