Introduction: Neonates with Hypoplastic Left Heart Syndrome (HLHS) and additional risk factors constitute a particularly vulnerable population with high early mortality . Objectives: To evaluate an integrated, multidisciplinary management strategy for high-risk HLHS. Methods: We retrospectively analyzed 67 consecutive neonates with HLHS treated at the Children’s University Hospital in Cracow between November 2017 and December 2023. All patients had ≥1 predefined risk factor: birth weight