Bilateral pulmonary artery banding in higher risk neonates with hypoplastic left heart syndromeCentral MessagePerspective
Harold M. Burkhart, MD,
Yuki Nakamura, MD,
Anas Salkini, MD,
Randall M. Schwartz, MD,
Courtney D. Ranallo, MD,
Elizabeth S. Makil, MD,
Matthew Campbell, MD,
Suanne M. Daves, MD,
Emilie D. Henry, MD,
Arshid Mir, MD
Affiliations
Harold M. Burkhart, MD
Division of Cardiovascular and Thoracic Surgery, University of Oklahoma Health Sciences Center, Oklahoma City, Okla; Address for reprints: Harold M. Burkhart, MD, Division of Cardiovascular and Thoracic Surgery, University of Oklahoma Health Sciences Center, P.O. Box 26901, WP-2230, Oklahoma City, OK 73105.
Yuki Nakamura, MD
Division of Cardiovascular and Thoracic Surgery, University of Oklahoma Health Sciences Center, Oklahoma City, Okla
Anas Salkini, MD
Section of Pediatric Cardiology, University of Oklahoma Health Sciences Center, Oklahoma City, Okla
Randall M. Schwartz, MD
Department of Anesthesia, University of Oklahoma Health Sciences Center, Oklahoma City, Okla
Courtney D. Ranallo, MD
Section of Pediatric Critical Care, University of Oklahoma Health Sciences Center, Oklahoma City, Okla
Elizabeth S. Makil, MD
Section of Pediatric Cardiology, University of Oklahoma Health Sciences Center, Oklahoma City, Okla
Matthew Campbell, MD
Section of Pediatric Cardiology, University of Oklahoma Health Sciences Center, Oklahoma City, Okla
Suanne M. Daves, MD
Department of Anesthesia, University of Oklahoma Health Sciences Center, Oklahoma City, Okla
Emilie D. Henry, MD
Section of Pediatric Critical Care, University of Oklahoma Health Sciences Center, Oklahoma City, Okla
Arshid Mir, MD
Section of Pediatric Cardiology, University of Oklahoma Health Sciences Center, Oklahoma City, Okla
Objectives: Limited data on performing bilateral pulmonary artery banding (BPAB) before stage 1 Norwood procedure suggest that some patients may benefit through the postponement of the major cardiopulmonary bypass procedure. The objective of this study was to evaluate the effectiveness of BPAB in the surgical management of high-risk patients with hypoplastic left heart syndrome (HLHS). Methods: A retrospective review of all high-risk neonates with HLHS who underwent BPAB at our institution was performed. No patients, including those with intact or highly restrictive atrial septum (IAS), were excluded. Results: Between October 2015 and April 2021, 49 neonates with HLHS (including 6 with IAS) underwent BPAB, 40 of whom progressed to the Norwood procedure. Risk factors for not progressing to the Norwood procedure after BPAP include low birth weight (P = .043), the presence of multiple extracardiac anomalies (P = .005), and the presence of genetic disorders (P = .028). Operative mortality was 7.5% (3/40). IAS was associated with operative mortality (P = .022). Conclusions: The strategy of BPAB prestage 1 Norwood procedure was successful in identifying at-risk patients and improving Norwood survival. Although not all patients will need this hybrid approach, a significant number can be expected to benefit from this tactic. These results support the need for a substantial hybrid strategy, in addition to a primary stage 1 Norwood surgical strategy, in the management of HLHS.
