Effectiveness of the Aortic Extended Anastomosis with Pulmonary Artery Banding in Neonates with Single Ventricle and Aortic Arch Obstruction

Yuriy Kulyabin, Yuriy Gorbatykh, Ilya Soynov, Nataliya Nichay, Alexey Zubritskiy

National Medical Research Center named by acad.Meshalkin, Novosibirsk, Russia

Date, time and location: 2018.05.26 08:30, Press Hall, 2F

Abstract

Background: Neonates with single ventricle (SV) and aortic arch obstruction (AAO) represent a complex group of patients with high risk of mortality. The best surgical management is controversial. A staged palliative approach with aortic arch reconstruction and pulmonary artery banding (PAB) is an alternative to Damus-Kaye-Stansel procedure (DKS).

This retrospective study is aimed to assess early and late outcomes in patients with SV and AAO without prior signs of subaortic obstruction (SAO) who underwent PAB and aortic arch reconstruction with extended end-to-end anastomosis (EEEA).

Materials and methods: 24 patients with SV and AAO without signs of SAO underwent palliative repair in period from 2006 to 2016. All patients underwent PAB and EEEA in neonatal period as the first stage of palliation. Median age was 21 (IQR 15; 26) days. Median follow up was 12 (IQR 10; 18) months.

Results: There were 3 early deaths (12.5%). Two patients (8.3%) died in late postoperative period due to non-cardiac reasons. SAO was developed in 12 patients (63.1%), who required DKS at the second stage, only 2 of them were defined as candidates for bidirectional cavopulmonary anastomosis (BCPA). Seven patients had no signs of SAO and underwent isolated BCPA (36.9%). One patient (5.2%) died in the early postoperative period after the DKS procedure. Recoarctation was occurred in 1 patient (5.2%). The DKS with recoarctation repair was performed to this patient.

We revealed that gradient on the pulmonary band affects development of SAO during follow-up (p=0.011).

Conclusion: PAB with EEEA in SV patients without prior SAO has high rate of SAO development and necessity of DKS. PAB is associated with high risk of SAO development. Due to high risk of unfavorable outcomes, the initial palliation with the DKS procedure could be appropriate surgical approach in this group of patients.