Faculty Collaboration Database

Bilateral pulmonary artery banding as rescue intervention in high-risk neonates. Ann Thorac Surg 2013 Sep;96(3):885-90

Date

08/07/2013

Pubmed ID

23916808

DOI

10.1016/j.athoracsur.2013.05.049

Scopus ID

2-s2.0-84883239384 (requires institutional sign-in at Scopus site)   20 Citations

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.

Author List

Russell RA, Ghanayem NS, Mitchell ME, Woods RK, Tweddell JS

Authors

Rebecca Ann Bertrandt MD Associate Professor in the Pediatrics department at Medical College of Wisconsin
Michael Edward Mitchell MD Chief, Professor in the Surgery department at Medical College of Wisconsin
Ronald K. Woods MD Professor in the Surgery department at Medical College of Wisconsin

MESH terms used to index this publication - Major topics in bold

Alprostadil
Cardiopulmonary Bypass
Cohort Studies
Female
Follow-Up Studies
Heart Defects, Congenital
Humans
Infant, Newborn
Ligation
Male
Palliative Care
Preoperative Care
Pulmonary Artery
Retrospective Studies
Risk Assessment
Severity of Illness Index
Survival Rate
Treatment Outcome
Vascular Surgical Procedures
Ventricular Outflow Obstruction