Early results of bilateral pulmonary artery banding for hypoplastic left heart syndrome☆

Abstract

Objective: To compare the haemodynamics and perioperative course of initial palliation with bilateral pulmonary artery banding (PAB) and the Norwood procedure. Methods: Between April 2004 and December 2007, 43 consecutive children with hypoplastic left heart syndrome (HLHS) or a variant underwent initial palliation (PAB, n = 18; Norwood, n = 25). Clinical perioperative data were analysed. In the PAB group, lipoprostaglandin E1 administration was continued with hospitalisation until stage 2 palliation with a bi-directional Glenn shunt and the Norwood procedure. Results: There were no significant differences in the age and operative weight of patients who received stage 1 palliation (PAB, 12 AE 9 days, 2.7 AE 0.6 kg; Norwood, 12 AE 8 days, 2.8 AE 0.4 kg). The PAB group had more high-risk patients than the Norwood group (PAB, 83%; Norwood, 48%, p = 0.04). Increased early and inter-stage mortality were observed in patients who underwent the Norwood procedure (early mortality with PAB, 6% vs Norwood, 12%; inter-stage mortality, 6% vs 27%, respectively). Mortality between stages 1 and 2 was 11% for the PAB group and 36% for the Norwood group. The Kaplan-Meier survival estimate at 1 year did not differ between groups (77% for the PAB group, 64% for the Norwood group). Ductal stenosis was found in one patient in the PAB group during the follow-up period. Twenty-eight patients underwent stage 2 reconstruction, and the patients in the PAB group were younger at the time of surgery (PAB, 116 days; Norwood, 224 days). There were no significant differences between groups in pulmonary artery index regarding body surface area (BSA) (PAB, 179 mm 2 BSA À1 ; Norwood, 194 mm 2 BSA À1 ) and the incidence of ventricular dysfunction after stage 2 construction (PAB, 21%; Norwood, 21%). Conclusions: Bilateral PAB with continuous lipo-prostaglandin E1 administration may improve early and intermediate mortality in infants with HLHS. Intimate care with hospitalisation may contribute to the results. #

Bilateral pulmonary artery banding for initial palliation in high-risk hypoplastic left heart syndrome

“…4,5,8,9 Stenting the ductus arteriosus has the advantage of adequate blood flow regulation and it avoids the disadvantages associated with the long-term use of prostaglandin E1, such as thinning of the ductal wall, abrupt closure or even aneurismal rupture. Rupture, migration and in-stent stenosis are not rare complications related to ductal stenting.…”

“…7 Since then, this initial palliation has gradually attracted attention because it is less invasive. 4,5,8,9 Appropriate regulation of PA flow and ductus maintenance are the two most critical issues in minimally-invasive procedures. Apparently, the original design of PA banding was not suitable in complicated cases.…”

The hybrid approach for palliation of hypoplastic left heart syndrome: Intermediate results of a single-center experience

“…30 Some authors have even modified the hybrid approach and propose a partial hybrid stage I palliation in the form of bilateral PA banding with continuous PGE1 administration. 31 It may be used as a bailout or salvage approach, 32 providing excellent palliation for patients for whom transplantation is considered the most appropriate long-term approach. In such circumstances the time pressure to find a suitable donor heart is relieved and the child is likely to be exposed to fewer blood products, reducing problems with later organ matching.…”

A new technique for the correction of hypoplastic left heart syndrome

“…Hybrid approaches involving the maintenance of the patent ductus arteriosus with the implantation of a stent (10,11) or the prolonged administration of prostaglandin E1 (12) associated with the banding of the pulmonary branches simplifies the surgical approach but have yielded unsatisfactory results (13,14). …”