Hybrid approach to HeartMate II left ventricular assist device exchange

We chose bilateral PAB to minimize risks of complete repair of multiple VSDs in the neonatal period and to reduce potential complications of neoaortic valve insufficiency or root dilation. Palliation can improve physiology, cause some VSDs to close or become restrictive, allow easier technical repair of remaining VSDs, and limit aortic valve insufficiency and root dilation. Recently, the use of Amplatzer septal occluder devices (St Jude Medical, Inc, St Paul, Minn) has been described in older children with multiple VSDs; however, there have been no reports involving neonates. The staged approach described here may be a viable low-risk alternative for patients with TGA and multiple midmuscular and apical VSDs.