There are two stages:

1st Stage:  It is performed either in an operating room with cardiac catherization capability or in a cardiac catherterization suite. The surgeon will perform a median sternotomy and place bilateral artery bands at the take off of the left pulmonary artery and on the right pulmonary artery between the aorta and superior vena cava. The bands are made from a 3.5 mm polytetrafluoroethylene tube graft. Bands are adjusted to achieve a distal pulmonary artery pressure of 17-20mm Hg. An introducer sheath is then placed through the main pulmonary artery. A stent is put in the ductus. Just before the stent is put in, a balloon atrial septostomy and if needed a stent are performed to maintain the atrial communication.

2nd Stage:

After the hybrid procedure a comprehensive stage two procedure is done. This is done when the child is 4 to 6 months old. It starts as the cardiopulmonary bypass is initiated. The pulmonary artery bands are removed and the arteries are augmented as needed. The stent is removed and the aortic reconstruction is performed as in a Norwood operation: The aortic arch is enlarged by disconnecting the small ascending aorta and connecting the aorta with the pulmonary root to make one large vessel. A bidirectional Glenn or hemi-Fontan is performed, depending on surgeons preference. This procedure can not be done immediately after birth because the pulmonary resistance is too high to allow for passive blood flow to the lungs.