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Objective: Minimally invasive operations and percutaneous interventions are well-accepted options in the treatment of congenital heart defects.However, percutaneous interventions may be associated with an increased risk due to limited vascular access or a very tortuous catheter course.In these cases, combining operative and interventional approaches with direct puncture of the heart or the great vessels may facilitate implantation of even large devices.Methods: Between 01/2000 and 06/2009 17 patients were operated in a hybrid fashion.Age ranged from 14 days to 45 years.Operative procedures consisted of implantation of ASD or VSD occluders (n=5), implantation or re-dilation of isthmus or ductal stents (n=7), angioplasty of the PA (n=2), stent implantation into the PA or RVOT (n=2), occlusion of an intrahepatic porto-caval shunt (n=1), and atrioseptoplasty combined with a bilateral PA banding in a newborn with a SV and very low birth weight (n=1).Results: In all cases, the primary hemodynamic objectives were achieved.The Aristotle Basic Score dropped significantly from 6.75±2.43 (theoretical score without intervention) to 5.38±2.70 (actual score with intervention) (p=0.001), the expected mortality according to the EACTS database from 7.09±6.18 % (theoretical mortality risk without intervention) to 3.80±3.60 % (actual mortality risk with intervention) (p=0.005).Conclusions: In selected patients, the combination of a surgical procedure and a percutaneous intervention may help to reduce both operative and interventional risks.This concept may enable new treatment options, especially in patients with complex congenital heart defects or complex vascular situations.