title: Staged surgical approach to neonates with aortic obstruction and single-ventricle physiology.
abstract: BACKGROUND
  The surgical management of neonatal systemic outflow obstruction and complex single ventricle pathology is variable.
  
  
  METHODS
  In 15 neonates (12 boys and 3 girls) with complex forms of single-ventricle pathology and aortic coarctation or interruption, an initial strategy of banding the pulmonary artery and repair of the obstruction from a left thoracotomy was undertaken.
  
  
  RESULTS
  The median age at operation was 6 days (range 2 to 33 days) and the median weight was 3.3 kg (range 2 to 4.6 kg). There were no early deaths and one late death after the initial surgical palliation. Of the 14 survivors, 8 have undergone a bidirectional cavopulmonary anastomosis. The median age for bidirectional Glenn was 9.75 months (range 3.5 to 26 months). Seven infants have required Damus-Kaye-Stansel reconstruction for subaortic obstruction (one early death). The median age of the Damus-Kaye-Stansel procedure was 4 months (range 3 weeks to 9 months). Thirteen of 15 patients (87%) are alive and 6 have proceeded to a Fontan operation (median follow-up 68 months). A single failing Fontan required takedown to bidirectional Glenn and central shunt.
  
  
  CONCLUSIONS
  Our experience suggests that this high-risk subgroup of neonates with aortic obstruction and single-ventricle pathophysiology is safely managed by initial pulmonary artery banding palliation and repair of aortic obstruction. This strategy, careful surveillance, and early relief of subaortic stenosis can maintain acceptable anatomy and hemodynamics for later bidirectional Glenn and Fontan procedures.
authors.affiliation: Division of Cardiothoracic Surgery, University of California, Los Angeles Medical Center, 90095, USA.
authors.forename: J N
authors.initials: JN
authors.lastname: Odim
authors.forename: H
authors.initials: H
authors.lastname: Laks
authors.forename: D C
authors.initials: DC
authors.lastname: Drinkwater
authors.forename: B L
authors.initials: BL
authors.lastname: George
authors.forename: J
authors.initials: J
authors.lastname: Yun
authors.forename: M
authors.initials: M
authors.lastname: Salem
authors.forename: V
authors.initials: V
authors.lastname: Allada
mesh_terms: D001017:Aortic Coarctation / Q000601:surgery*; D006348:Cardiac Surgical Procedures / Q000379:methods; D005260:Female; D005500:Follow-Up Studies; D006330:Heart Defects, Congenital / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D006352:Heart Ventricles / Q000002:abnormalities*; D006801:Humans; D007231:Infant, Newborn; D008297:Male; D011183:Postoperative Complications