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Long-Term Results of Bilateral Pulmonary Artery Banding Versus Primary Norwood Procedure

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Abstract

Bilateral pulmonary artery banding (PAB) has emerged to be an attractive option as an initial procedure for the treatment of hypoplastic left heart syndrome (HLHS), and some centers report excellent survival. However, its usage is variable among institutions and its true efficacy is unknown due to reporting biases. We aimed to describe the results of bilateral PAB use, preoperative risk factors, and long-term outcomes compared with primary Norwood procedure, using a national database. Infants who underwent bilateral PAB or Norwood procedure as an initial palliation for HLHS between January 2008 and December 2012 listed in the Japan Congenital Cardiovascular Surgery Database (JCCVSD) were included. The total number of patients diagnosed with HLHS was 334. Bilateral PABs were performed for 256 patients and primary Norwood procedures for 78 patients, as an initial procedure. Actuarial 5-year survival was 59.0%. The primary Norwood procedure group had better 5-year survival [75.5%; 95% confidence interval (CI) 63.2–84.1] than the bilateral PAB group (75.5 vs. 54.0%, log-rank p < 0.001). However, the bilateral PAB group had more significant risk factors. When the risk-adjusted outcomes were evaluated, there was no significant difference between the primary Norwood group and the bilateral PAB group (76.4 vs. 78.1%, log-rank p = 0.87) in higher volume institutions. The primary Norwood group had better 5-year survival than the bilateral PAB group, but preoperative risk was higher in the bilateral PAB group. Because outcomes are comparable when performed at higher HLHS volume institutions, proper patient selection is important in achieving good long-term result.

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References

  1. Mahle WT, Cuadrado AR, Tam VKH (2003) Early experience with a modified Norwood procedure using right ventricle to pulmonary artery conduit. Ann Thorac Surg 76:1084–1088. doi:10.1016/S0003-4975(03)00343-6

    Article  PubMed  Google Scholar 

  2. Sano S, Ishino K, Kado H, Shiokawa Y, Sakamoto K, Yokota M et al (2004) Outcome of right ventricle-to-pulmonary artery shunt in first-stage palliation of hypoplastic left heart syndrome: a multi-institutional study. Ann Thorac Surg 78:1951–1958. doi:10.1016/j.athoracsur.2004.05.055

    Article  PubMed  Google Scholar 

  3. Akintuerk H, Michel-Behnke I, Valeske K, Mueller M, Thul J, Bauer J et al (2002) Stenting of the arterial duct and banding of the pulmonary arteries. Circulation. doi:10.1161/hc0902.104709

    PubMed  Google Scholar 

  4. Galantowicz M (2013) In favor of the hybrid stage 1 as the initial palliation for hypoplastic left heart syndrome. Semin Thorac Cardiovasc Surg Pediatr Card Surg Annu 16:62–64. doi:10.1053/j.pcsu.2013.01.005

    Article  PubMed  Google Scholar 

  5. Yerebakan C, Valeske K, Elmontaser H, Yörüker U (2015) Hybrid therapy for hypoplastic left heart syndrome: Myth, alternative, or standard? J Thorac Cardiovasc Surg. doi:10.1016/j.jtcvs.2015.10.066

    Google Scholar 

  6. Venugopal PS, Luna KP, Anderson DR, Austin CB, Rosenthal E, Krasemann T et al (2010) Hybrid procedure as an alternative to surgical palliation of high-risk infants with hypoplastic left heart syndrome and its variants. J Thorac Cardiovasc Surg 139:1211–1215. doi:10.1016/j.jtcvs.2009.11.037

    Article  PubMed  Google Scholar 

  7. Galantowicz M, Yates AR (2016) Improved outcomes with the comprehensive stage 2 procedure after an initial hybrid stage 1. J Thorac Cardiovasc Surg 151:424–429. doi:10.1016/j.jtcvs.2015.10.023

    Article  PubMed  Google Scholar 

  8. Karamlou T, Overman D, Hill KD, Wallace A, Pasquali SK, Jacobs JP et al (2015) Stage 1 hybrid palliation for hypoplastic left heart syndrome-assessment of contemporary patterns of use: an analysis of the society of thoracic surgeons congenital heart surgery database. J Thorac Cardiovasc Surg 149(195–202):e1. doi:10.1016/j.jtcvs.2014.08.020

    Google Scholar 

  9. Miyata H, Murakami A, Tomotaki A, Takaoka T, Konuma T, Matsumura G et al (2014) Predictors of 90-day mortality after congenital heart surgery: the first report of risk models from Japan congenital cardiovascular surgery database (JCCVSD). J Thorac Cardiovasc Surg 148:2201–2206. doi:10.1016/j.jtcvs.2013.01.053

    Article  PubMed  Google Scholar 

  10. Hoashi T, Miyata H, Murakami A, Hirata Y, Hirose K, Matsumura G et al (2015) The current trends of mortality following congenital heart surgery: the Japan congenital cardiovascular surgery database. Interact Cardiovasc Thorac Surg 21:151–156. doi:10.1093/icvts/ivv109

    Article  PubMed  Google Scholar 

  11. Ohye RG, Sleeper LA, Mahony L, Newburger JW, Pearson GD, Lu M et al (2010) Comparison of shunt types in the Norwood procedure for single-ventricle lesions. N Engl J Med 362:1980–1992. doi:10.1056/NEJMoa0912461

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  12. Bacha EA (2013) Individualized approach in the management of patients with hypoplastic left heart syndrome (HLHS). Semin Thorac Cardiovasc Surg Pediatr Card Surg Annu 16:3–6. doi:10.1053/j.pcsu.2013.01.001

    Article  PubMed  Google Scholar 

  13. Stasik CN, Goldberg CS, Bove EL, Devaney EJ, Ohye RG (2006) Current outcomes and risk factors for the Norwood procedure. J Thorac Cardiovasc Surg. doi:10.1016/j.jtcvs.2005.09.030

    PubMed  Google Scholar 

  14. Sakamoto T, Harada Y, Kosaka Y, Umezu K, Yasukochi S, Takigiku K et al (2011) Second-stage palliation after bilateral pulmonary artery bands for HLHS and its variants-which is better, modified Norwood or Norwood plus bidirectional glenn? World J Pediatr Congenit Heart Surg 2:558–565. doi:10.1177/2150135111415428

    Article  PubMed  Google Scholar 

  15. Ota N, Murata M, Tosaka Y, Ide Y, Tachi M, Ito H et al (2014) Is routine rapid-staged bilateral pulmonary artery banding before stage 1 Norwood a viable strategy? J Thorac Cardiovasc Surg. doi:10.1016/j.jtcvs.2013.11.053

    PubMed  Google Scholar 

  16. Kitahori K, Murakami A, Takaoka T, Takamoto S, Ono M (2010) Precise evaluation of bilateral pulmonary artery banding for initial palliation in high-risk hypoplastic left heart syndrome. J Thorac Cardiovasc Surg 140:1084–1091. doi:10.1016/j.jtcvs.2010.07.084

    Article  PubMed  Google Scholar 

  17. Jonas RA (2010) Why I believe the hybrid Norwood is inferior to the Norwood/sano procedure. World J Pediatr Congenit Heart Surg 1:161–162. doi:10.1177/2150135110370355

    Article  PubMed  Google Scholar 

  18. Davies RR, Radtke W, Bhat MA, Baffa JM, Woodford E, Pizarro C (2015) Hybrid palliation for critical systemic outflow obstruction: neither rapid stage 1 Norwood nor comprehensive stage 2 mitigate consequences of early risk factors. J Thorac Cardiovasc Surg 149:182–191. doi:10.1016/j.jtcvs.2014.09.030

    Article  PubMed  Google Scholar 

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Acknowledgements

We thank Ms. Asako Ooi for her invaluable assistance with data collection and research organization.

Funding

This study was funded by JSPS KAKENHI Grant Number JP26462083.

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Authors and Affiliations

  1. Department of Cardiac Surgery, The University of Tokyo, Bunkyo, Japan

    Yasutaka Hirata

  2. Department of Health Policy and Management, School of Medicine, Keio University, Shinjuku, Japan

    Hiroaki Miyata & Norimichi Hirahara

  3. Department of Cardiac Surgery, Kanazawa Cardiovascular Hospital, Kanazawa, Japan

    Arata Murakami

  4. Department of Cardiovascular Surgery, Fukuoka Children’s Hospital, Fukuoka, Japan

    Hideaki Kado

  5. Department of Cardiovascular Surgery, Mt. Fuji Shizuoka Children’s Hospital, Shizuoka, Japan

    Kisaburo Sakamoto

  6. Department of Surgery, UCSF School of Medicine, San Francisco, CA, USA

    Shunji Sano

  7. Department of Cardiovascular Surgery, Mitsui Memorial Hospital, Chiyoda, Japan

    Shinichi Takamoto

Authors
  1. Yasutaka Hirata
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  2. Hiroaki Miyata
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  3. Norimichi Hirahara
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  4. Arata Murakami
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  5. Hideaki Kado
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  6. Kisaburo Sakamoto
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  7. Shunji Sano
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  8. Shinichi Takamoto
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Correspondence to Yasutaka Hirata.

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The authors have no conflict of interest.

Ethical Approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the Japan Congenital Cardiovascular Surgery Database and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Informed Consent

Since this is a retrospective analysis of the collected data, the Japanese Cardiovascular Surgery Database Organization Committee granted permission to access and analyze the data with a waiver of informed consent.

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Hirata, Y., Miyata, H., Hirahara, N. et al. Long-Term Results of Bilateral Pulmonary Artery Banding Versus Primary Norwood Procedure. Pediatr Cardiol 39, 111–119 (2018). https://doi.org/10.1007/s00246-017-1735-1

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  • DOI: https://doi.org/10.1007/s00246-017-1735-1

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