Does Bilateral Pulmonary Banding in Comparison to Norwood Procedure Improve Outcome in Neonates with Hypoplastic Left Heart Syndrome Beyond Second-Stage Palliation? A Review of the Current Literature

Abstract

Best evidence protocol was applied and the question addressed, whether there is an outcome advantage of a hybrid approach including bilateral pulmonary banding (BPB) and ductal stenting over Norwood procedure (NP) to maintain systemic circulation and to restrict pulmonary blood flow in neonates with hypoplastic left heart syndrome (HLHS). Out of 80 articles published since the original description of BPB in 2002, eight were selected to answer the clinical question. All studies were retrospective case-series after BLB, only three compared results with NP controls, but not in a randomized fashion. Only three chose high-risk patients. Mean follow-up interval was mentioned only in one study. Reported mean hospital, interstage, and stage 2 mortalities after BPB was 17.3, 12.4, and 25.3%, respectively. Estimated transplant-free survival beyond stage 2 palliation ranged from 7 to 80%, with no significant differences to NP controls in three studies. Reintervention rate was high, ranging from 20 to 42% at different sites. Due to study design or inhomogeneity of patient groups, current literature does not show evidence that bilateral pulmonary banding improves outcome with respect to survival beyond second-stage HLHS palliation.

Keywords

bilateral banding - hybrid - hypoplastic left heart - Norwood operation

• References

• 1 Dunning J, Prendergast B, Mackway-Jones K. Towards evidence-based medicine in cardiothoracic surgery: best BETS. Interact Cardiovasc Thorac Surg 2003; 2 (4) 405-409
• 2 Akintuerk H, Michel-Behnke I, Valeske K , et al. Stenting of the arterial duct and banding of the pulmonary arteries: basis for combined Norwood stage I and II repair in hypoplastic left heart. Circulation 2002; 105 (9) 1099-1103
• 3 Galli KK, Zimmerman RA, Jarvik GP , et al. Periventricular leukomalacia is common after neonatal cardiac surgery. J Thorac Cardiovasc Surg 2004; 127 (3) 692-704
• 4 Hasegawa T, Yamaguchi M, Yoshimura N, Okita Y. The dependence of myocardial damage on age and ischemic time in pediatric cardiac surgery. J Thorac Cardiovasc Surg 2005; 129 (1) 192-198
• 5 Karimi M, Wang LX, Hammel JM , et al. Neonatal vulnerability to ischemia and reperfusion: Cardioplegic arrest causes greater myocardial apoptosis in neonatal lambs than in mature lambs. J Thorac Cardiovasc Surg 2004; 127 (2) 490-497
• 6 Licht DJ, Wang J, Silvestre DW , et al. Preoperative cerebral blood flow is diminished in neonates with severe congenital heart defects. J Thorac Cardiovasc Surg 2004; 128 (6) 841-849
• 7 Bacha EA, Daves S, Hardin J , et al. Single-ventricle palliation for high-risk neonates: the emergence of an alternative hybrid stage I strategy. J Thorac Cardiovasc Surg 2006; 131 (1) 163-171, e2
• 8 Mahle WT, Visconti KJ, Freier MC , et al. Relationship of surgical approach to neurodevelopmental outcomes in hypoplastic left heart syndrome. Pediatrics 2006; 117 (1) e90-e97
• 9 Pizarro C, Murdison KA, Derby CD, Radtke W. Stage II reconstruction after hybrid palliation for high-risk patients with a single ventricle. Ann Thorac Surg 2008; 85 (4) 1382-1388
• 10 Honjo O, Benson LN, Mewhort HE , et al. Clinical outcomes, program evolution, and pulmonary artery growth in single ventricle palliation using hybrid and Norwood palliative strategies. Ann Thorac Surg 2009; 87 (6) 1885-1892, discussion 1892–1893
• 11 Sakurai T, Kado H, Nakano T , et al. Early results of bilateral pulmonary artery banding for hypoplastic left heart syndrome. Eur J Cardiothorac Surg 2009; 36 (6) 973-979
• 12 Pilla CB, Pedra CA, Nogueira AJ , et al. Hybrid management for hypoplastic left heart syndrome: an experience from Brazil. Pediatr Cardiol 2008; 29 (3) 498-506
• 13 Galantowicz M, Cheatham JP, Phillips A , et al. Hybrid approach for hypoplastic left heart syndrome: intermediate results after the learning curve. Ann Thorac Surg 2008; 85 (6) 2063-2070, discussion 2070–2071
• 14 Venugopal PS, Luna KP, Anderson DR , et al. Hybrid procedure as an alternative to surgical palliation of high-risk infants with hypoplastic left heart syndrome and its variants. J Thorac Cardiovasc Surg 2010; 139 (5) 1211-1215
• 15 Norwood WI, Lang P, Hansen DD. Physiologic repair of aortic atresia-hypoplastic left heart syndrome. N Engl J Med 1983; 308 (1) 23-26
• 16 Lai L, Laussen PC, Cua CL , et al. Outcomes after bidirectional Glenn operation: Blalock-Taussig shunt versus right ventricle-to-pulmonary artery conduit. Ann Thorac Surg 2007; 83 (5) 1768-1773
• 17 O'Brien SM, Clarke DR, Jacobs JP , et al. An empirically based tool for analyzing mortality associated with congenital heart surgery. J Thorac Cardiovasc Surg 2009; 138 (5) 1139-1153
• 18 Sinzobahamvya N, Photiadis J, Kumpikaite D , et al. Comprehensive Aristotle score: implications for the Norwood procedure. Ann Thorac Surg 2006; 81 (5) 1794-1800
• 19 Furck AK, Uebing A, Hansen JH , et al. Outcome of the Norwood operation in patients with hypoplastic left heart syndrome: a 12-year single-center survey. J Thorac Cardiovasc Surg 2010; 139 (2) 359-365
• 20 Ghanayem NS, Hoffman GM, Mussatto KA , et al. Home surveillance program prevents interstage mortality after the Norwood procedure. J Thorac Cardiovasc Surg 2003; 126 (5) 1367-1377
• 21 Tabbutt S, Dominguez TE, Ravishankar C , et al. Outcomes after the stage I reconstruction comparing the right ventricular to pulmonary artery conduit with the modified Blalock Taussig shunt. Ann Thorac Surg 2005; 80 (5) 1582-1590, discussion 1590–1591
• 22 Li J, Zhang G, Benson L , et al. Comparison of the profiles of postoperative systemic hemodynamics and oxygen transport in neonates after the hybrid or the Norwood procedure: a pilot study. Circulation 2007; 116 (11, Suppl) I179-I187
• 23 Ohye RG, Gaynor JW, Ghanayem NS , et al; Pediatric Heart Network Investigators. Design and rationale of a randomized trial comparing the Blalock-Taussig and right ventricle-pulmonary artery shunts in the Norwood procedure. J Thorac Cardiovasc Surg 2008; 136 (4) 968-975