Hybrid Procedure with Pulmonary Arterial Banding and PDA Stent as Bridging to Biventricular Correction

Objectives: Hybrid procedure with ductus stent and bilateral pulmonary banding offers a temporary therapeutic approach in children with complex congenital heart defects, but it may also have negative impact concerning postbanding stenosis or impaired development of pulmonary arteries.

Methods: We identified 11 patients between 2012 and 2019 who underwent hybrid procedure and staged biventricular repair. Surgical and interventional procedures on cardiac defect were collected, as well as interventional and surgical treatment on pulmonary vessels. As follow-up parameters survival, craniocaudal blood pressure gradient, echocardiographic marker for left ventricular dimensions, and systolic function were investigated. For assessment of pulmonary growth, diameter of left and right pulmonary arteries was used.

Result: Patient collective consisted of cases with complex cardiac anatomy with sub- or supravalvular aortic stenosis plus interrupted aortic arch (five patients) or coarctation aortae (six patients). Pulmonary banding and ductus stent were placed at the mean age of 13 days with median weight of 3.1 kg and were in place for a mean of 229 days (95% CI: 187–271 days). The overall survival was 91% for a follow-up time of 19 months (95% CI: 7.6–31 months). Postoperative results concerning left ventricular (LV) function showed normal LV dimensions and systolic function (z-score LVEDd −0.4 [95% CI: −1.4 to 0.5]; z-score IVSd 1.3 [95% CI: 0.5–2.0]; z-score LVPWd 2.1 [95% CI: 1.4–3.0]; LV FS 42.1% [95% CI: 37.0–47.1%]) without relevant stenosis in former aortic isthmus area (bp upper vs. lower extremity 8.4 mm Hg [95% CI: 1.6–15.2 mm Hg]; Vmax in echocardiographic Doppler measurement 2.1 m/s [95% CI: 1.7–2.6 m/s]). Concerning pulmonary arterial growth and stenosis, pulmonary banding was associated with impaired peripheral arterial growth in medium term after debanding and residual stenosis necessitated interventions in 5 of 10 cases.

Conclusion: Hybrid procedure as temporary treatment as bridging for biventricular repair in children with ductus dependent perfusion of systemic circulation shows good postoperative results with low perioperative mortality and normal left ventricular function but is often associated with the need of interventions due to pulmonary stenosis.

Publication History

Article published online:
21 February 2021