Biventricular Repair following Bilateral Pulmonary Artery Banding in High-Risk Patients with Hypoplastic Left Heart

Background: The hybrid palliation involving bilateral pulmonary artery banding and ductal stenting has emerged as an alternative strategy for patients with ductal-dependent systemic circulation. Herein, we present the initial outcomes of biventricular repair following initial bilateral pulmonary artery banding in high-risk patients with hypoplastic left heart complex and variants at our institution.

Method: Thirty-six high-risk patients with hypoplastic left heart syndrome and variants underwent bilateral pulmonary artery banding from 2018 to 2022. Six patients with hypoplastic left heart complex and variants received biventricular repair following initial banding with/out ductal stenting. Median (range) birth and weight at surgery were 2.1 kg (1.8–3.5) and 2.9 kg (1.7–3.7), respectively. Median age at initial surgery was 8 days. Median weight and age at the time of biventricular repair were 6.2 kg (3.2–7.3) and 6.5 (0.6–7.3) months. Four (66.7%) patients underwent ductal stenting after bilateral pulmonary artery banding and two were treated with continuous PGE1 infusion. Patients underwent aortic arch patch repair, bilateral branch pulmonary artery patch plasty/dilatation, and partial ASD closure with fenestration. Concomitant aortic and/or mitral valve repair was performed in two patients. Complete and partial atrioventricular septal defect repairs were performed in two patients, and another patient underwent a Yasui operation.

Results: There was no operative or midterm mortality. No surgical or catheter intervention was required after the biventricular repair. All patients are still alive and doing well on the last follow-up. One other patient with hypoplastic left heart complex received a heart transplant.

Conclusion: Hybrid approach for the hypoplastic left heart complex and variants alleviates the need of immediate decision making as well as a major surgery in the neonatal period and favors an excellent outcome for high-risk patients after biventricular repair at a later stage in life.

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Artikel online veröffentlicht:
28. Januar 2023