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Abdelmohsen GA, Gabel HA, Alamri RM, Baamer A, Al-Radi OO, Binyamin A, Jamjoom AA, Elmahrouk AF, Bahaidarah SA, Alkhushi NA, Abdelsalam MH, Ibrahim H, Elakaby AR, Khawaji A, Alghobaishi A, Maghrabi KA, Zaher ZF, Al-Ata JA, Azhar AS, Dohain AM. Bidirectional glenn surgery without palliative pulmonary artery banding in univentricular heart with unrestricted pulmonary flow. Retrospective multicenter experience. J Cardiothorac Surg 2024; 19:67. [PMID: 38321557 PMCID: PMC10845678 DOI: 10.1186/s13019-024-02572-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2023] [Accepted: 01/30/2024] [Indexed: 02/08/2024] Open
Abstract
BACKGROUND Although pulmonary artery banding (PAB) has been generally acknowledged as an initial palliative treatment for patients having single ventricle (SV) physiology and unrestrictive pulmonary blood flow (UPBF), it may result in unfavorable outcomes. Performing bidirectional Glenn (BDG) surgery without initial PAB in some selected cases may avoid the complications associated with PAB and reduce the number of operative procedures for these patients. This research aimed to assess the outcome of BDG surgery performed directly without doing initial PAB in patients with SV-UPBF. METHODS This Multicenter retrospective cohort includes all patients with SV-UPBF who had BDG surgery. Patients were separated into two groups. Patients in Group 1 included patients who survived till they received BDG (20 Patients) after initial PAB (28 patients), whereas patients in Group 2 got direct BDG surgery without first performing PAB (16 patients). Cardiac catheterization was done for all patients before BDG surgery. Patients with indexed pulmonary vascular resistance (PVRi) ≥ 5 WU.m2 at baseline or > 3 WU.m2 after vasoreactivity testing were excluded. RESULTS Compared with patients who had direct BDG surgery, PAB patients had a higher cumulative mortality rate (32% vs. 0%, P = 0.016), with eight deaths after PAB and one mortality after BDG. There were no statistically significant differences between the patient groups who underwent BDG surgery regarding pulmonary vascular resistance, pulmonary artery pressure, postoperative usage of sildenafil or nitric oxide, intensive care unit stay, or hospital stay after BDG surgery. However, the cumulative durations in the intensive care unit (ICU) and hospital were more prolonged in patients with BDG after PAB (P = 0.003, P = 0.001respectively). CONCLUSION Direct BDG surgery without the first PAB is related to improved survival and shorter hospital stays in some selected SV-UPBF patients.
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Affiliation(s)
- Gaser A Abdelmohsen
- Pediatric Cardiology Division, Department of Pediatrics, King Abdulaziz University, P.O.BOX: 80215, Jeddah, 21589, Saudi Arabia.
- Pediatric Cardiology Division, Department of Pediatrics, Kasr Al Ainy School of Medicine, Cairo University, 99 El-Manial St., Cairo, 11451, Egypt.
| | - Hala A Gabel
- Pediatric Cardiology Division, Department of Pediatrics, King Abdulaziz University, P.O.BOX: 80215, Jeddah, 21589, Saudi Arabia
| | - Rawan M Alamri
- Cardiac Surgery Division, Department of Surgery, King Abdulaziz University, P.O.BOX: 80215, Jeddah, 21589, Saudi Arabia
| | - Ahmed Baamer
- Pediatric Cardiology Division, Department of Pediatrics, King Abdulaziz University, P.O.BOX: 80215, Jeddah, 21589, Saudi Arabia
| | - Osman O Al-Radi
- Cardiac Surgery Division, Department of Surgery, King Abdulaziz University, P.O.BOX: 80215, Jeddah, 21589, Saudi Arabia
- Division of Cardiac Surgery, Cardiovascular Department, King Faisal Specialist Hospital and Research Center, P.O. Box 40047, Jeddah, 21499, Saudi Arabia
| | - Aliaa Binyamin
- Pediatric Cardiology Division, Department of Pediatrics, King Abdulaziz University, P.O.BOX: 80215, Jeddah, 21589, Saudi Arabia
| | - Ahmed A Jamjoom
- Division of Cardiac Surgery, Cardiovascular Department, King Faisal Specialist Hospital and Research Center, P.O. Box 40047, Jeddah, 21499, Saudi Arabia
| | - Ahmed F Elmahrouk
- Division of Cardiac Surgery, Cardiovascular Department, King Faisal Specialist Hospital and Research Center, P.O. Box 40047, Jeddah, 21499, Saudi Arabia
- Cardiothoracic Surgery Department, Tanta University, Tanta, Egypt
| | - Saud A Bahaidarah
- Pediatric Cardiology Division, Department of Pediatrics, King Abdulaziz University, P.O.BOX: 80215, Jeddah, 21589, Saudi Arabia
| | - Naif A Alkhushi
- Pediatric Cardiology Division, Department of Pediatrics, King Abdulaziz University, P.O.BOX: 80215, Jeddah, 21589, Saudi Arabia
| | - Mohamed H Abdelsalam
- Pediatric Cardiology Division, Department of Pediatrics, King Abdulaziz University, P.O.BOX: 80215, Jeddah, 21589, Saudi Arabia
- Cardiology Department, Benha University, Benha, Egypt
| | - Hossam Ibrahim
- Pediatric Cardiology Division, Department of Pediatrics, Kasr Al Ainy School of Medicine, Cairo University, 99 El-Manial St., Cairo, 11451, Egypt
| | - Ahmed R Elakaby
- Pediatric Cardiology Division, Department of Pediatrics, King Abdulaziz University, P.O.BOX: 80215, Jeddah, 21589, Saudi Arabia
- Pediatric department, Al-Azhar University, Cairo, Egypt
| | - Adeep Khawaji
- Department of Pediatrics, King Fahad Armed Forces Hospital, Jeddah, Saudi Arabia
| | - Abdullah Alghobaishi
- Department of Pediatrics, King Fahad Armed Forces Hospital, Jeddah, Saudi Arabia
| | - Khadijah A Maghrabi
- Pediatric Cardiology Division, Department of Pediatrics, King Abdulaziz University, P.O.BOX: 80215, Jeddah, 21589, Saudi Arabia
| | - Zaher F Zaher
- Pediatric Cardiology Division, Department of Pediatrics, King Abdulaziz University, P.O.BOX: 80215, Jeddah, 21589, Saudi Arabia
| | - Jameel A Al-Ata
- Pediatric Cardiology Division, Department of Pediatrics, King Abdulaziz University, P.O.BOX: 80215, Jeddah, 21589, Saudi Arabia
| | - Ahmad S Azhar
- Pediatric Cardiology Division, Department of Pediatrics, King Abdulaziz University, P.O.BOX: 80215, Jeddah, 21589, Saudi Arabia
| | - Ahmed M Dohain
- Pediatric Cardiology Division, Department of Pediatrics, King Abdulaziz University, P.O.BOX: 80215, Jeddah, 21589, Saudi Arabia
- Pediatric Cardiology Division, Department of Pediatrics, Kasr Al Ainy School of Medicine, Cairo University, 99 El-Manial St., Cairo, 11451, Egypt
- Department of Pediatrics, King Fahad Armed Forces Hospital, Jeddah, Saudi Arabia
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Langanecha BD, Kesavan S, Schwartz SM, Honjo O, Seed M, Fan CPS, Dragulescu A, Taylor KL, Floh AA. Reintervention Before Bidirectional Cavopulmonary Shunt and Intermediate Outcomes in Children with Single Ventricle Who Underwent Main Pulmonary Artery Banding. Pediatr Cardiol 2023; 44:1839-1846. [PMID: 37522934 DOI: 10.1007/s00246-023-03242-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/26/2023] [Accepted: 07/14/2023] [Indexed: 08/01/2023]
Abstract
Unplanned reinterventions following pulmonary artery banding (PAB) in single ventricle patients are common before stage 2 palliation (S2P) but associated risk factors are unknown. We hypothesized that reintervention is more common when PAB is placed at younger age and with a looser band, reflected by lower PAB pressure gradient. Retrospective single center study of single ventricle patients undergoing PAB between Jan 2000 and Dec 2020. The association with reintervention and successful S2P was modeled using exploratory cause-specific hazard regression. A multivariable model was developed adjusting for clinical and statistically relevant predictors. The cumulative proportion of patients undergoing reintervention were summarized using a competing risk model. 77 patients underwent PAB at median (IQR) 47 (24-66) days and 3.73 (3.2-4.5) kg. Within18 months of PAB, 60 (78%) reached S2P, 9 (12%) died, 1 (1%) transplanted and 7 (9%) were alive without S2P. Within 18 months of PAB 10 (13%) patients underwent reintervention related to pulmonary blood flow modification: PAB adjustment (n = 6) and conversion to Damus-Kaye-Stansel/Blalock-Taussig-Thomas shunt (n = 4). 6/10 (60%) reached S2P following reintervention. A trend toward higher intervention in patients with a genetic syndrome (p-0.06) and weight < 3 kg (p-0.057) at time of PAB was noted. Only genetic syndrome was a risk factor associated with poor outcome (p-0.025). PAB has a reasonable outcome in SV patients with unobstructed systemic and pulmonary blood flow, but with a high reintervention rate. Only a quarter of patients with genetic syndromes reach S2P and further study is required to explore the benefits from an alternative palliative strategy.
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Affiliation(s)
- Bhavikkumar D Langanecha
- Labatt Family Heart Centre, Division of Pediatric Cardiology, Department of Pediatrics, University of Toronto, Hospital for Sick Children, 555 University Avenue, Toronto, ON, M5G 1X8, Canada.
| | - Sajith Kesavan
- Department of Paediatric Pulmonary and Critical Care, Amrita Institute of Medical Sciences, Kochi, India
| | - Steven M Schwartz
- Labatt Family Heart Centre, Division of Pediatric Cardiology, Department of Pediatrics, University of Toronto, Hospital for Sick Children, 555 University Avenue, Toronto, ON, M5G 1X8, Canada
- Department of Critical Care Medicine, University of Toronto, The Hospital for Sick Children, Toronto, Canada
| | - Osami Honjo
- Labatt Family Heart Centre, Division of Cardiovascular Surgery, Department of Surgery, University of Toronto, The Hospital for Sick Children, Toronto, Canada
| | - Mike Seed
- Labatt Family Heart Centre, Division of Pediatric Cardiology, Department of Pediatrics, University of Toronto, Hospital for Sick Children, 555 University Avenue, Toronto, ON, M5G 1X8, Canada
| | - Chun-Po S Fan
- Ted Rogers Computational Program, The University Health Network, University of Toronto, Toronto, ON, Canada
| | - Andreea Dragulescu
- Labatt Family Heart Centre, Division of Pediatric Cardiology, Department of Pediatrics, University of Toronto, Hospital for Sick Children, 555 University Avenue, Toronto, ON, M5G 1X8, Canada
| | - Katherine L Taylor
- Division of Cardiac Anaesthesia, Department of Anaesthesia, University of Toronto, The Hospital for Sick Children, Toronto, Canada
| | - Alejandro A Floh
- Labatt Family Heart Centre, Division of Pediatric Cardiology, Department of Pediatrics, University of Toronto, Hospital for Sick Children, 555 University Avenue, Toronto, ON, M5G 1X8, Canada
- Department of Critical Care Medicine, University of Toronto, The Hospital for Sick Children, Toronto, Canada
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Kido T, Steringer MT, Vodiskar J, Burri M, Ewert P, Strbad M, Cleuziou J, Hager A, Hörer J, Ono M. Improved Long-term Outcome of Damus-Kaye-Stansel Procedure without Previous Pulmonary Artery Banding. Ann Thorac Surg 2021; 114:545-551. [PMID: 34087235 DOI: 10.1016/j.athoracsur.2021.05.022] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2021] [Revised: 04/22/2021] [Accepted: 05/06/2021] [Indexed: 11/16/2022]
Abstract
BACKGROUND We sought to determine long-term outcomes of primary Damus-Kaye-Stansel procedure in patients with functional single ventricle and to compare the results to our historical control in whom pulmonary artery banding was performed before the Damus-Kaye-Stansel procedure. METHODS We reviewed the medical records of all patients who underwent Damus-Kaye-Stansel procedure at the German Heart Center of Munich between December 1994 and December 2019. RESULTS Damus-Kaye-Stansel procedure was performed as an initial palliation in 52 patients (primary DKS group) and as a staged palliation following pulmonary artery banding in 24 patients (staged DKS group). The median follow up period after Damus-Kaye-Stansel procedure was 8.9 years in the primary DKS group and 8.0 years in the staged DKS group. The survival rate at 10 years after Damus-Kaye-Stansel procedure were 89% in primary DKS group and 68% in staged DKS group (log-rank: p= 0.04). Before total cavopulmonary connection, the pressure gradient thorough systemic ventricular outflow tract was significantly lower in primary DKS group than staged DKS group (p<0.001). At last follow-up echocardiography, reduced ventricular function was observed in 1 patient in primary DKS group and 7 patients in staged DKS group (p<0.001). The degree of neo aortic regurgitation was significantly higher in staged DKS group than in primary DKS group (p <0.001). CONCLUSIONS Primary Damus-Kaye-Stansel procedure in patients with functional single ventricle and potential systemic ventricular outflow tract obstruction is recommended to obtain favorable long term survival with preserved ventricular function and competent semilunar valve function.
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Affiliation(s)
- Takashi Kido
- Department of congenital and pediatric heart surgery, German Heart Center Munich, Technical University of Munich, Division of congenital and pediatric heart surgery, University Hospital of Munich, Ludwig-Maximilians-Universität, Munich, Germany
| | - Maria-Theresa Steringer
- Department of congenital and pediatric heart surgery, German Heart Center Munich, Technical University of Munich, Division of congenital and pediatric heart surgery, University Hospital of Munich, Ludwig-Maximilians-Universität, Munich, Germany
| | - Janez Vodiskar
- Department of congenital and pediatric heart surgery, German Heart Center Munich, Technical University of Munich, Division of congenital and pediatric heart surgery, University Hospital of Munich, Ludwig-Maximilians-Universität, Munich, Germany
| | - Melchior Burri
- Department of Cardiovascular Surgery, German Heart Center Munich at the Technical University of Munich, Munich, Germany
| | - Peter Ewert
- Department of Pediatric Cardiology and Congenital Heart Disease, German Heart Center Munich at the Technical University of Munich, Munich, Germany
| | - Martina Strbad
- Department of congenital and pediatric heart surgery, German Heart Center Munich, Technical University of Munich, Division of congenital and pediatric heart surgery, University Hospital of Munich, Ludwig-Maximilians-Universität, Munich, Germany
| | - Julie Cleuziou
- Department of congenital and pediatric heart surgery, German Heart Center Munich, Technical University of Munich, Division of congenital and pediatric heart surgery, University Hospital of Munich, Ludwig-Maximilians-Universität, Munich, Germany
| | - Alfred Hager
- Department of Pediatric Cardiology and Congenital Heart Disease, German Heart Center Munich at the Technical University of Munich, Munich, Germany
| | - Jürgen Hörer
- Department of congenital and pediatric heart surgery, German Heart Center Munich, Technical University of Munich, Division of congenital and pediatric heart surgery, University Hospital of Munich, Ludwig-Maximilians-Universität, Munich, Germany
| | - Masamichi Ono
- Department of congenital and pediatric heart surgery, German Heart Center Munich, Technical University of Munich, Division of congenital and pediatric heart surgery, University Hospital of Munich, Ludwig-Maximilians-Universität, Munich, Germany.
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Thang BQ, Furugaki T, Osaka M, Watanabe Y, Kanemoto S, Suetsugu F, Hiramatsu Y. Mid-Term Outcomes of a Modification of Extended Aortic Arch Anastomosis with Pulmonary Artery Banding in Single Ventricle Neonates with Hypoplastic Transverse Arch. Ann Thorac Cardiovasc Surg 2016; 22:340-347. [PMID: 27725352 DOI: 10.5761/atcs.oa.16-00170] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
PURPOSE There is less certainty regarding the best strategy for treating neonates with functional single ventricle (SV) and hypoplastic aortic arch. We have applied a modified extended aortic arch anastomosis (EAAA) and main pulmonary artery banding (PAB) as an initial palliation in neonates with transverse arch hypoplasia and assessed the mid-term outcomes. METHODS In total, 10 neonates with functional SV and extensive hypoplasia or interruption of the arch underwent a modified EAAA (extended arch anastomosis with a subclavian flap) concomitant with main PAB through a thoracotomy without cardiopulmonary bypass. Patient age and weight ranged from 4 to 14 days and 2.3 to 3.8 kg, respectively. RESULTS There were no hospital deaths although there were two late deaths. Gradients across the arch were 0 to 7 mmHg at postoperative day 1 and no arch reoperations were required. Two patients required balloon aortoplasty. Nine underwent bidirectional cavopulmonary shunt and two of them needed concomitant Damus-Kaye-Stansel (DKS) anastomosis. Six have completed Fontan. CONCLUSION Our modification of EAAA with main PAB for SV neonates may benefit a certain population with transverse arch hypoplasia as an option to be considered. Patients with the potential for developing outflow obstruction may be best managed with an initial DKS-type palliation.
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Affiliation(s)
- Bui Quoc Thang
- Department of Cardiovascular Surgery, University of Tsukuba, Tsukuba, Ibaraki, Japan
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