The National Institute for Health and Clinical Excellence (NICE) issued full guidance to the NHS in England, Wales, Scotland and Northern Ireland on hybrid procedure for interim management of hypoplastic left heart syndrome in neonates in December 2007. In accordance with the Interventional Procedures Programme Process Guide, guidance on procedures with special arrangements are reviewed 3 years after publication and the procedure is reassessed if important new evidence is available.

The guidance was considered for reassessment in January 2011 and it was concluded that NICE will not be updating this guidance at this stage. However, if you believe there is new evidence which should warrant a review of our guidance, please contact us via the email address below.


Some babies are born with a poorly developed left side of their heart. The hybrid procedure is a combination of surgical and 'endovascular' techniques to help establish blood flow to and from the left side of the heart. It is performed soon after birth with the aim of delaying more major surgery until the baby is older and better able to withstand it.

The hybrid procedure involves both surgery, in which bands are placed around the branches of the pulmonary artery, and catheterisation techniques, in which stents (metal mesh tubes) are inserted to keep the ductus arteriosus open.

Coding recommendations

L03.2 Percutaneous transluminal stent implantation into arterial duct

L76.- Endovascular placement of stent or L89.- Other endovascular placement of stent

L12.1 Application of band to pulmonary artery

Y49.1 Median sternotomy approach

If endovascular banding of pulmonary artery is carried out, then  L13.8 Other specified transluminal operations on pulmonary artery is assigned, instead of L12.1 and Y49.1

K16.1 Percutaneous transluminal balloon atrial septostomy

Y53.- Approach to organ under image control

Note: The individual components of the hybrid procedure may be carried out synchronously or may be staged depending on individual patient need.

Codes within categories L76.-  and  L89.- are used to specify the type of stent used; if the type of stent is not specified in the clinical record L76.9 Unspecified endovascular placement of stent is assigned. Please note that the .8 and .9 codes from extended category L89 must not be used.

Codes within category Y53.-  are used as secondary codes to classify interventions that are percutaneous and require some form of image control: if the method of image control is unspecified,Y53.9 Unspecified approach to organ under image control is assigned.

In addition the ICD-10 code Q23.4 Hypoplastic left heart syndrome would be recorded on the baby’s record.