Effectiveness of Bilateral Pulmonary Artery Banding in Patients with Hypoplastic Left Heart Syndrome and Congenital Heart Defects with a Functional Single Ventricle: A Single-Center Retrospective Study

摘要

Background:Bilateral banding of the branches of the pulmonary artery in patients with hypoplastic left heart syndrome(HLHS)and other duct dependent critical neonatal heart malformations can significantly reduce the incidence of severe complications in the postoperative period,especially in severely unstable patients.In our study we compared different surgical techniques of bilateral pulmonary artery banding(PAB)in respect to their success in balancing systemic and pulmonary blood flow.Methods:We included 44 neonates with a HLHS and congenital heart diseases(CHD)with a functional single ventricle underwent a hybrid operation:bilateral PAB and patent ductus arteriosus stenting.The hybrid surgery for method No.1 is performed as a one-stage procedure,together with patent ductus arteriosus(PDA)stenting.After median sternotomy,two Gore-Tex 1–2 mm wide bands with a diameter of 3–3.5 mm are put.When we apply method No.2 then the thread is used to create bands.Method No.3 is distinguished by intraoperative assessment of blood flow at the site of narrowing of the branches of the pulmonary artery and optional stenting of the PDA.The cuff for banding is made of Gore-Tex tubing.Effectiveness when applying method Nos.1 and 2 is assessed by the change in invasive blood pressure and oxygen saturation after narrowing of the branches of the pulmonary artery.Also,with these techniques PDA stenting by inserting the introducer via pulmonary artery trunk is performed.Results:HLHS with mitral or aortic valve atresia or both was present in 19 patients(43.1%),with severe left heart obstruction resulting in PDA dependent systemic circulation in 16 babies(36.4%).CHD with single ventricle physiology occurred in 9 patients(20.5%).14 babies(31.8%)undergo the procedure following the method No.1,8 patients(18.2%)method No.2 and 22 patients(50%)method No.3.Qp/Qs=1/1 was achieved in 30 patients(30/44,68.1%):as a result of the method No.1 was achieved in 5 patients(5/14,35.7%),method No.2 in 4 patients(4/8,50%),method No.3 in 21 patients(21/22,95.5%).Multivariate regression analysis revealed that method No.3 significantly increases the chances of hemodynamic efficacy operations(OR=35.0;p=0.005;CI(95%)3–411.5).Conclusion:Application of the operation technique No.3 in combination with the intraoperative assessment of blood flow parameters at the site of banding of the branches of the pulmonary artery are the most optimal criteria for achieving Qp/Qs=1/1.If there are signs of restriction at the level of the foramen ovale,atrioseptostomy should be done in the second stage after bilateral pulmonary banding.