title: Expectations and limitations after bilateral pulmonary artery banding.
abstract: OBJECTIVE
  Bilateral pulmonary artery banding (bil-PAB) has been developed as a part of a hybrid procedure for hypoplastic left heart syndrome (HLHS). We use this procedure for palliation of complex congenital heart disease, particularly in patients with arch anomaly. We reviewed our experience with bil-PAB.
  
  
  METHODS
  Sixty-six consecutive cases between 2003 and 2014 were reviewed retrospectively.
  
  
  RESULTS
  Fifty-one patients (77%) had single ventricle physiology (HLHS: 37, HLHS variant: 13, others: 1). Twelve patients had biventricular physiology [5 interrupted aortic arch with ventricular septal defect (VSD); 4 coarctation of the aorta with VSD; 2 truncus arteriosus; 1 other]. In 3 patients, it was difficult to determine if the physiology was single ventricle or biventricle due to borderline left ventricle size. Age and body weight at the time of operation were 4.3 ± 3.4 days and 2.7 ± 0.5 kg, respectively. Overall hospital mortality was 11% (7/66). Of the 42 patients from 2010, only 1 with multiple anomalies died between bil-PAB and the second-stage operation. Thirteen patients (20%) required reoperation of bil-PAB. The mean waiting time for the next operation was 44.3 ± 42.8 days. The body weight at the second-stage operation was 3.2 ± 0.8 kg. Seven (11%) patients developed patent ductus arteriosus obstruction during the waiting period. Twenty-four patients were 2.5 kg or less; 20 patients in this group progressed to the second-stage operation and of these 19 gained body weight. Forty-two patients were above 2.5 kg, but of these only 23 patients gained body weight. Ten patients underwent bil-PAB because of shock and 8 of these recovered from shock. In 2 borderline cases, the patients underwent the Norwood procedure and 1 patient had arch repair and VSD closure.
  
  
  CONCLUSIONS
  Bil-PAB could be applied to a wide variety of complex diseases. Our mortality rates with bil-PAB improved significantly post-2010. Good indications for bil-PAB were shock and situations where it was unclear whether the physiology was single ventricle or biventricular. Body weight gain was difficult to predict, but patients weighing less than 2.5 kg could be expected to gain body weight after the procedure.
authors.affiliation: Department of Cardiovascular Surgery, Chukyo Children's Heart Center, Chukyo Hospital, Nagoya, Japan tasakurai-ths@umin.ac.jp.
authors.forename: Takahisa
authors.initials: T
authors.lastname: Sakurai
authors.affiliation: Department of Cardiovascular Surgery, Chukyo Children's Heart Center, Chukyo Hospital, Nagoya, Japan.
authors.forename: Hajime
authors.initials: H
authors.lastname: Sakurai
authors.affiliation: Department of Cardiovascular Surgery, Chukyo Children's Heart Center, Chukyo Hospital, Nagoya, Japan.
authors.forename: Koji
authors.initials: K
authors.lastname: Yamana
authors.affiliation: Department of Cardiovascular Surgery, Chukyo Children's Heart Center, Chukyo Hospital, Nagoya, Japan.
authors.forename: Toshimichi
authors.initials: T
authors.lastname: Nonaka
authors.affiliation: Department of Cardiovascular Surgery, Chukyo Children's Heart Center, Chukyo Hospital, Nagoya, Japan.
authors.forename: Rei
authors.initials: R
authors.lastname: Noda
authors.affiliation: Department of Cardiovascular Surgery, Chukyo Children's Heart Center, Chukyo Hospital, Nagoya, Japan.
authors.forename: Ryohei
authors.initials: R
authors.lastname: Otsuka
authors.affiliation: Department of Cardiovascular Surgery, Chukyo Children's Heart Center, Chukyo Hospital, Nagoya, Japan.
authors.forename: Takuya
authors.initials: T
authors.lastname: Osawa
mesh_terms: D006801:Humans; D018636:Hypoplastic Left Heart Syndrome / Q000601:surgery*; D007231:Infant, Newborn; D058327:Norwood Procedures / Q000379:methods; D011651:Pulmonary Artery / Q000601:surgery*; D012086:Reoperation; D016896:Treatment Outcome; D014338:Truncus Arteriosus / Q000601:surgery; D015430:Weight Gain
keywords: Coarctation of the aorta; Hypoplastic left heart syndrome; Interrupted aortic arch