Early- and midterm outcomes of pulmonary artery band as an initial palliation in patients with single ventricle associated with unrestricted pulmonary blood flow
10.3760/cma.j.issn.0529-5815.2019.12.013
- VernacularTitle: 利用肺动脉环缩术行功能性单心室合并非限制性肺血流第一期姑息治疗的早中期结果
- Author:
Minghui ZOU
1
;
Fan CAO
;
Li MA
;
Yuansheng XIA
;
Shengchun YANG
;
Weidan CHEN
;
Wenlei LI
;
Xinxin CHEN
Author Information
1. Department of Cardiac Surgery, Guangzhou Women and Children′s Medical Center, Guangzhou Medical University, Guangzhou 510623, China
- Publication Type:Journal Article
- Keywords:
Heart defects, congenital;
Hypertension, pulmonary;
Pulmonary artery banding;
Single ventricle
- From:
Chinese Journal of Surgery
2019;57(12):939-943
- CountryChina
- Language:Chinese
-
Abstract:
Objective:To examine the early- and midterm outcomes of pulmonary artery banding as an initial palliation in patients with single ventricle associated with unrestricted pulmonary blood flow.
Methods:Between January 2008 and December 2017, 49 patients with single ventricle and unrestricted pulmonary blood flow underwent pulmonary artery banding at Department of Cardiac Surgery, Guangzhou Women and Children′s Medical Center, Guangzhou Medical University. There were 29 males and 20 females. The age at the time of surgery was 5.6 (11.5) months (M(QR)), and the weight was 5.2 (3.9) kg. The medical records and results after pulmonary artery banding (death/reoperation, transition to the Glenn procedure) and subsequently after the Glenn procedure (death, transition to the Fontan procedure) were reviewed retrospectively. Actuarial survivals were estimated by the Kaplan-Meier curve. Relative factors for affecting outcomes were analyzed using the Cox regression hazard model.
Results:There were 8 early deaths, with a mortality of 16.3%, including 4 cases who received simultaneous arch repair. There were 5 late deaths. During the follow-up of 47(62) (M(QR)) months, 11 patients (22.4%) underwent pulmonary artery banding adjustment, 29 patients (59.2%) underwent the Glenn procedure, 21 patients (42.8%) underwent the Fontan procedure. The survival of patients after the initial pulmonary artery banding were 77.4% (95%CI: 65.6% to 89.2%) and 72.6% (95%CI: 59.9% to 85.3%) at 1 year and 5 years, respectively. Multivariate Cox regression analysis revealed that systemic ventricular outflow tract obstruction (HR=4.25, 95%CI: 1.50 to 12.03, P=0.006) and total anomalous pulmonary venous connection (HR=6.49, 95%CI: 3.24 to 12.98, P=0.000) were relative factors for death.
Conclusions:The early and midterm outcomes of pulmonary artery banding as an initial palliative strategy is not satisfactory. Systemic ventricular outflow tract obstruction and total anomalous pulmonary venous connection are associated with high mortality.
