title: Bilateral pulmonary artery banding as rescue intervention in high-risk neonates.
abstract: BACKGROUND
  Presentation in shock and preoperative infection remain risk factors for neonatal cardiac surgery. This report describes bilateral pulmonary artery banding (bPAB) in ductal-dependent lesions with systemic outflow obstruction as rescue intervention before surgery with cardiopulmonary bypass in these high-risk neonates.
  
  
  METHODS
  A retrospective chart review was conducted for 10 patients who underwent bPAB before conventional surgery with cardiopulmonary bypass. Patient characteristics including birth weight, gestational age, cardiac and noncardiac diagnoses, preoperative and postoperative markers of organ function, and outcome measures were examined.
  
  
  RESULTS
  The majority of patients (8 of 10) were considered high-risk owing to multiorgan dysfunction syndrome. The median age at bPAB was 12 days (range, 5 to 26 days), and the median interval between bPAB and second surgery was 10.5 days (range, 5 to 79 days). Organ function improved after admission and continued to improve after bPAB in 9 of 10 patients. No patient experienced new complications between bPAB and subsequent operation. Of 8 patients who had stage I palliation, 5 have undergone or are awaiting completion Fontan, 1 underwent Kawashima procedure, 1 underwent orthotopic heart transplant, and 1 with hypoplastic left heart syndrome and intact atrial septum died at 44 days old. Both patients who underwent biventricular repair are alive and well. Median follow-up for survivors was 2.9 years (range, 0.25 to 6.25 years).
  
  
  CONCLUSIONS
  Bilateral pulmonary artery banding is safe in ductal-dependent lesions with systemic outflow obstruction. High-risk patients with preoperative organ dysfunction or infection can recover within a short period and become lower risk candidates for complex congenital heart surgery using cardiopulmonary bypass.
authors.affiliation: Division of Critical Care, Department of Pediatrics, Medical College of Wisconsin and Herma Heart Center at Children's Hospital of Wisconsin, Milwaukee, Wisconsin 53201, USA. rarussel@mcw.edu
authors.forename: Rebecca A
authors.initials: RA
authors.lastname: Russell
authors.forename: Nancy S
authors.initials: NS
authors.lastname: Ghanayem
authors.forename: Michael E
authors.initials: ME
authors.lastname: Mitchell
authors.forename: Ronald K
authors.initials: RK
authors.lastname: Woods
authors.forename: James S
authors.initials: JS
authors.lastname: Tweddell
mesh_terms: D000527:Alprostadil / Q000627:therapeutic use; D002315:Cardiopulmonary Bypass / Q000379:methods / Q000401:mortality; D015331:Cohort Studies; D005260:Female; D005500:Follow-Up Studies; D006330:Heart Defects, Congenital / Q000175:diagnosis / Q000401:mortality / Q000601:surgery*; D006801:Humans; D007231:Infant, Newborn; D008026:Ligation / Q000379:methods; D008297:Male; D010166:Palliative Care / Q000379:methods*; D011300:Preoperative Care / Q000379:methods; D011651:Pulmonary Artery / Q000601:surgery*; D012189:Retrospective Studies; D018570:Risk Assessment; D012720:Severity of Illness Index; D015996:Survival Rate; D016896:Treatment Outcome; D014656:Vascular Surgical Procedures / Q000379:methods; D014694:Ventricular Outflow Obstruction / Q000175:diagnosis / Q000401:mortality / Q000601:surgery*
chemical_list: D000527:Alprostadil
keywords: 21