Bilateral pulmonary artery banding in higher risk neonates with hypoplastic left heart syndromeCentral MessagePerspective
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 th...
| Main Authors: | , , , , , , , , , |
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| Format: | Article |
| Language: | English |
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Elsevier
2023-12-01
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| Series: | JTCVS Open |
| Subjects: | |
| Online Access: | http://www.sciencedirect.com/science/article/pii/S2666273623002176 |
| _version_ | 1797384999649935360 |
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| author | 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 |
| author_facet | 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 |
| author_sort | Harold M. Burkhart, MD |
| collection | DOAJ |
| description | 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. |
| first_indexed | 2024-03-08T21:47:47Z |
| format | Article |
| id | doaj.art-17dd85361a5040dbb72ec006dfd75f55 |
| institution | Directory Open Access Journal |
| issn | 2666-2736 |
| language | English |
| last_indexed | 2024-03-08T21:47:47Z |
| publishDate | 2023-12-01 |
| publisher | Elsevier |
| record_format | Article |
| series | JTCVS Open |
| spelling | doaj.art-17dd85361a5040dbb72ec006dfd75f552023-12-20T07:38:05ZengElsevierJTCVS Open2666-27362023-12-0116689697Bilateral pulmonary artery banding in higher risk neonates with hypoplastic left heart syndromeCentral MessagePerspectiveHarold M. Burkhart, MD0Yuki Nakamura, MD1Anas Salkini, MD2Randall M. Schwartz, MD3Courtney D. Ranallo, MD4Elizabeth S. Makil, MD5Matthew Campbell, MD6Suanne M. Daves, MD7Emilie D. Henry, MD8Arshid Mir, MD9Division 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.Division of Cardiovascular and Thoracic Surgery, University of Oklahoma Health Sciences Center, Oklahoma City, OklaSection of Pediatric Cardiology, University of Oklahoma Health Sciences Center, Oklahoma City, OklaDepartment of Anesthesia, University of Oklahoma Health Sciences Center, Oklahoma City, OklaSection of Pediatric Critical Care, University of Oklahoma Health Sciences Center, Oklahoma City, OklaSection of Pediatric Cardiology, University of Oklahoma Health Sciences Center, Oklahoma City, OklaSection of Pediatric Cardiology, University of Oklahoma Health Sciences Center, Oklahoma City, OklaDepartment of Anesthesia, University of Oklahoma Health Sciences Center, Oklahoma City, OklaSection of Pediatric Critical Care, University of Oklahoma Health Sciences Center, Oklahoma City, OklaSection of Pediatric Cardiology, University of Oklahoma Health Sciences Center, Oklahoma City, OklaObjectives: 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.http://www.sciencedirect.com/science/article/pii/S2666273623002176hypoplastic left heart syndromebilateral pulmonary artery bandsNorwoodcongenital cardiac surgerysingle-ventricle palliation |
| spellingShingle | 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 Bilateral pulmonary artery banding in higher risk neonates with hypoplastic left heart syndromeCentral MessagePerspective JTCVS Open hypoplastic left heart syndrome bilateral pulmonary artery bands Norwood congenital cardiac surgery single-ventricle palliation |
| title | Bilateral pulmonary artery banding in higher risk neonates with hypoplastic left heart syndromeCentral MessagePerspective |
| title_full | Bilateral pulmonary artery banding in higher risk neonates with hypoplastic left heart syndromeCentral MessagePerspective |
| title_fullStr | Bilateral pulmonary artery banding in higher risk neonates with hypoplastic left heart syndromeCentral MessagePerspective |
| title_full_unstemmed | Bilateral pulmonary artery banding in higher risk neonates with hypoplastic left heart syndromeCentral MessagePerspective |
| title_short | Bilateral pulmonary artery banding in higher risk neonates with hypoplastic left heart syndromeCentral MessagePerspective |
| title_sort | bilateral pulmonary artery banding in higher risk neonates with hypoplastic left heart syndromecentral messageperspective |
| topic | hypoplastic left heart syndrome bilateral pulmonary artery bands Norwood congenital cardiac surgery single-ventricle palliation |
| url | http://www.sciencedirect.com/science/article/pii/S2666273623002176 |
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