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Reintervention Before Bidirectional Cavopulmonary Shunt and Intermediate Outcomes in Children with Single Ventricle Who Underwent Main Pulmonary Artery Banding

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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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Abbreviations

PAB:

Pulmonary artery banding

SV:

Single ventricular

S2P:

Stage 2 palliation

AVSD:

Atrio-ventricular septal defects

BCPS:

Bidirectional cavopulmonary shunt

BTT:

Blalock–Taussig–Thomas

DKS:

Damus–Kaye–Stansel

T21:

Trisomy 21

ASD:

Atrial septal defect

DILV:

Double inlet left ventricle

VA:

Ventricular-arterial

VSD:

Ventricular septal defect

AVVR:

Atrioventricular valve regurgitation

Echo:

Echocardiographic

PDA:

Patent ductus arteriosus

PBF:

Pulmonary blood flow

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Authors and Affiliations

  1. 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

    Bhavikkumar D. Langanecha, Steven M. Schwartz, Mike Seed, Andreea Dragulescu & Alejandro A. Floh

  2. Department of Paediatric Pulmonary and Critical Care, Amrita Institute of Medical Sciences, Kochi, India

    Sajith Kesavan

  3. Department of Critical Care Medicine, University of Toronto, The Hospital for Sick Children, Toronto, Canada

    Steven M. Schwartz & Alejandro A. Floh

  4. Labatt Family Heart Centre, Division of Cardiovascular Surgery, Department of Surgery, University of Toronto, The Hospital for Sick Children, Toronto, Canada

    Osami Honjo

  5. Ted Rogers Computational Program, The University Health Network, University of Toronto, Toronto, ON, Canada

    Chun-Po S. Fan

  6. Division of Cardiac Anaesthesia, Department of Anaesthesia, University of Toronto, The Hospital for Sick Children, Toronto, Canada

    Katherine L. Taylor

Authors
  1. Bhavikkumar D. Langanecha
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  2. Sajith Kesavan
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  3. Steven M. Schwartz
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  4. Osami Honjo
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  5. Mike Seed
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  6. Chun-Po S. Fan
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  7. Andreea Dragulescu
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  8. Katherine L. Taylor
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  9. Alejandro A. Floh
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Contributions

SK and AAF: Conceptualize the study. SK and BDL : Data curation CSF: Data analysis and interpretation BL, SK, SMS, OH, KLT and AAF : Methodology and original draft SMS, OH, KT, MS, AD and AAF: Review and editing of the original draft.

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Correspondence to Bhavikkumar D. Langanecha.

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Langanecha, B.D., Kesavan, S., Schwartz, S.M. et al. Reintervention Before Bidirectional Cavopulmonary Shunt and Intermediate Outcomes in Children with Single Ventricle Who Underwent Main Pulmonary Artery Banding. Pediatr Cardiol 44, 1839–1846 (2023). https://doi.org/10.1007/s00246-023-03242-6

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  • DOI: https://doi.org/10.1007/s00246-023-03242-6

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