Abstract
Background This study reports midterm results of high-risk patients with hypoplastic left ventricle
treated with initial bilateral pulmonary artery banding (PAB) before secondary Norwood
procedure (NP).
Methods Retrospective study of 17 patients admitted between July 2012 and February 2017 who
underwent this treatment strategy because diagnosis or clinical status was associated
with high risk for NP. Survival was compared with that of patients who underwent primary
NP.
Results Mean Aristotle comprehensive complexity score for NP would have been 19.7 ± 2.6.
Risk factors included obstructed pulmonary venous return (n = 9), body weight < 2.5 kg (n = 7), total anomalous pulmonary venous connection (n = 3), and necrotizing enterocolitis (n = 1). Ten patients had a score ≥ 19.5. Early survival after PAB was 82.4% (14/17).
NP was performed in 14 patients after improvement of clinical condition at a median
age of 56 days and a weight ≥2,500 g. There was no 30-day mortality, but one interstage
death. One patient died later after Glenn operation. One-year survival after primary
PAB followed by NP was 70.6 ± 11.1%. During the same period, 35 patients with overall
lower risk factors underwent primary NP; early postoperative survival and 1-year survival
were 88.6 ± 5.4% and 68.6 ± 7.8%, respectively. There was no significant difference
in survival between the two groups (p = 0.83) despite higher risk in the secondary Norwood group (p <0.0001).
Conclusions PAB before NP in high-risk patients constituted salvage management. Primary PAB provided
enough time for stabilization and control of most risk factors. It allowed midterm
survival equivalent to the survival after primary NP in lower risk neonates.
Keywords
pulmonary artery banding - hypoplastic left heart syndrome - Norwood procedure - four-staged
palliation
