Evaluation of bilateral pulmonary artery banding for initial palliation in single-ventricle neonates and infants: risk factors for mortality before the bidirectional Glenn procedure.

Abstract

Bilateral pulmonary artery banding is considered as 'first-stage' palliation for neonates who have hypoplastic left heart syndrome. This study aimed to identify risk factors that influence outcome before the bidirectional Glenn operation. This retrospective evaluation involved 30 consecutive patients with hypoplastic left heart syndrome, or a variant, who underwent bilateral pulmonary artery banding between August 2005 and December 2011 at our institution. Clinical echocardiographic, operative and catheter examination data were reviewed. This study included 9 patients with hypoplastic left heart syndrome and 21 patients with variants. Bilateral pulmonary artery banding was performed at a median age of 7 days. Finally, 19 patients had the bidirectional Glenn operation performed (Group A), and the remaining 11 patients died before the bidirectional Glenn procedure (Group NA). Catheter evaluations before the bidirectional Glenn procedure were carried out at 97 ± 34 days. The mean pulmonary venous wedge pressure was significantly lower (Group A: 13.1 ± 3.1 mmHg vs Group NA: 22.9 ± 3.7 mmHg, P <0.01), systemic ventricular ejection fraction was higher (54.4 ± 10.7 vs 41.7 ± 9.9%, P <0.05), systemic ventricular end-diastolic pressure was lower (6.1 ± 2.4 vs 10.5 ± 3.6 mmHg, P <0.05) and the rate of patients with more than mild systemic atrioventricular valve regurgitation was lower in Group A than in Group NA (15.7 vs 62.5%, P <0.05). Multivariate logistic regression analysis showed that mean pulmonary venous wedge pressure was the most significant predictor of attaining the bidirectional Glenn anastomosis (odds ratio: 2.35, P <0.01). Postoperative atrioventricular valve regurgitation, cardiac function and mean pulmonary venous wedge pressure are closely correlated with mortality after bilateral pulmonary artery banding. Additional treatments, including operations, are considered to maintain cardiac function and not to raise pulmonary venous wedge pressure before the bidirectional Glenn procedure.