Early results of bilateral pulmonary artery banding for hypoplastic left heart syndrome.
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, lipo-prostaglandin 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+/-9 days, 2.7+/-0.6 kg; Norwood, 12+/-8 days, 2.8+/-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(-1); Norwood, 194 mm(2)BSA(-1)) 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.
Sakurai
Takahisa
T
Department of Cardiovascular Surgery, Fukuoka Children's Hospital, 2-5-1 Toujinmachi, Chuuo-ku, Fukuoka, 810-0063, Japan.
Kado
Hideaki
H
Nakano
Toshihide
T
Hinokiyama
Kazuhiro
K
Shiose
Akira
A
Kajimoto
Masaki
M
Joo
Kunihiko
K
Ueda
Yuichi
Y
D000527:Alprostadil / Q000627:therapeutic use; D003131:Combined Modality Therapy; D003250:Constriction; D004812:Epidemiologic Methods; D006801:Humans; D018636:Hypoplastic Left Heart Syndrome / Q000188:drug therapy / Q000601:surgery*; D007231:Infant, Newborn; D010166:Palliative Care / Q000379:methods; D011651:Pulmonary Artery / Q000601:surgery*; D016896:Treatment Outcome; D014665:Vasodilator Agents / Q000627:therapeutic use
D014665:Vasodilator Agents; D000527:Alprostadil