Background: Hypoplastic left heart syndrome (HLHS) is a severe and complex congenital heart defect characterized by the underdevelopment of the left-sided cardiac structures. Management of HLHS typically involves multiple staged surgical interventions, often requiring repeated use of cardiopulmonary bypass (CPB). Optimizing CPB strategies is crucial for improving outcomes in these patients.

Case Description: We present the case of a pediatric patient with HLHS who underwent eight surgical procedures, six of which involved the use of CPB. The case highlights the evolution of CPB management strategies across multiple operations, including transitions between peripheral and central cannulation techniques. Detailed clinical history, imaging findings, operative details, and postoperative outcomes were analyzed. Particular attention was paid to the challenges encountered during CPB weaning and the corresponding intraoperative interventions.

Conclusions: Our experience suggests that individualized CPB management, meticulous preoperative planning, and dynamic intraoperative adjustments are essential for optimizing surgical outcomes in complex HLHS cases.