Bahaaldin Alsoufi1, Cedric Manlhiot2, Alexandra Ehrlich3, Matthew Oster3, Brian Kogon4, William T Mahle3, Kevin Maher3, Brian W McCrindle2, Kirk Kanter4. 1. Division of Cardiothoracic Surgery, Children's Healthcare of Atlanta, Emory University School of Medicine, Atlanta, Ga. Electronic address: balsoufi@hotmail.com. 2. Labatt Family Heart Center, Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada. 3. Sibley Heart Center, Children's Healthcare of Atlanta, Emory University School of Medicine, Atlanta, Ga. 4. Division of Cardiothoracic Surgery, Children's Healthcare of Atlanta, Emory University School of Medicine, Atlanta, Ga.
Abstract
OBJECTIVES: Pulmonary artery banding is the initial palliative surgery in patients with single ventricle cardiac anomalies presenting with unrestricted pulmonary blood flow. Reported mortality in those receiving pulmonary artery banding is high, and its application in patients with single ventricle anomalies and arch obstruction is controversial. We report current-era results after pulmonary artery banding in patients with single ventricle anomalies, including those with arch obstruction. METHODS: Between 2002 and 2012, 73 patients with single ventricle anomalies and unrestricted pulmonary blood flow underwent pulmonary artery banding, including 29 (40%) who received simultaneous arch repair. Competing risk analysis modeled events after pulmonary artery banding (death/transplantation, transition to the Glenn procedure) and subsequently after the Glenn procedure (death/transplantation, transition to the Fontan procedure) and examined risk factors affecting outcomes. RESULTS: Hospital mortality was 3 of 73 patients (4%). Before the Glenn procedure, 16 patients (22%) underwent 18 reoperations, including shunt (n = 7), Damus-Kaye-Stansel connection plus shunt (n = 5), pulmonary artery banding adjustment (n = 5), and transplantation (n = 1). On competing risk analysis, 2 years after pulmonary artery banding, 8% of patients have died or received transplantation, 88% have undergone the Glenn procedure, and 7% were alive without the Glenn procedure. Five years after the Glenn procedure, 9% have died, 71% have undergone the Fontan procedure, and 20% were alive awaiting the Fontan procedure. Overall survival 5 years after pulmonary artery banding was 86%. On multivariable analysis, risk factors for mortality were associated genetic/extracardiac anomalies (hazard ratio, 3.7; 95% confidence interval, 1.1-12.2; P = .03) and high-risk morphology (heterotaxy, unbalanced atrioventricular septal defect, and mitral atresia) (hazard ratio, 4.1; 95% confidence interval, 1.1-15.6; P = .04). CONCLUSIONS: Pulmonary artery banding is an acceptable initial palliative strategy of selected patients with single ventricle cardiac anomalies and unrestricted pulmonary blood flow, including those with concomitant arch obstruction. Short- and long-term outcomes are generally good, although results diverge with the worst outcomes noted in patients with heterotaxy, unbalanced atrioventricular septal defect, or associated extracardiac anomalies.
OBJECTIVES: Pulmonary artery banding is the initial palliative surgery in patients with single ventricle cardiac anomalies presenting with unrestricted pulmonary blood flow. Reported mortality in those receiving pulmonary artery banding is high, and its application in patients with single ventricle anomalies and arch obstruction is controversial. We report current-era results after pulmonary artery banding in patients with single ventricle anomalies, including those with arch obstruction. METHODS: Between 2002 and 2012, 73 patients with single ventricle anomalies and unrestricted pulmonary blood flow underwent pulmonary artery banding, including 29 (40%) who received simultaneous arch repair. Competing risk analysis modeled events after pulmonary artery banding (death/transplantation, transition to the Glenn procedure) and subsequently after the Glenn procedure (death/transplantation, transition to the Fontan procedure) and examined risk factors affecting outcomes. RESULTS: Hospital mortality was 3 of 73 patients (4%). Before the Glenn procedure, 16 patients (22%) underwent 18 reoperations, including shunt (n = 7), Damus-Kaye-Stansel connection plus shunt (n = 5), pulmonary artery banding adjustment (n = 5), and transplantation (n = 1). On competing risk analysis, 2 years after pulmonary artery banding, 8% of patients have died or received transplantation, 88% have undergone the Glenn procedure, and 7% were alive without the Glenn procedure. Five years after the Glenn procedure, 9% have died, 71% have undergone the Fontan procedure, and 20% were alive awaiting the Fontan procedure. Overall survival 5 years after pulmonary artery banding was 86%. On multivariable analysis, risk factors for mortality were associated genetic/extracardiac anomalies (hazard ratio, 3.7; 95% confidence interval, 1.1-12.2; P = .03) and high-risk morphology (heterotaxy, unbalanced atrioventricular septal defect, and mitral atresia) (hazard ratio, 4.1; 95% confidence interval, 1.1-15.6; P = .04). CONCLUSIONS: Pulmonary artery banding is an acceptable initial palliative strategy of selected patients with single ventricle cardiac anomalies and unrestricted pulmonary blood flow, including those with concomitant arch obstruction. Short- and long-term outcomes are generally good, although results diverge with the worst outcomes noted in patients with heterotaxy, unbalanced atrioventricular septal defect, or associated extracardiac anomalies.