Long-Term Results of Bilateral Pulmonary Artery Banding Versus Primary Norwood Procedure

Yasutaka Hirata, Hiroaki Miyata, Norimichi Hirahara, Arata Murakami, Hideaki Kado, Kisaburo Sakamoto, Shunji Sano, Shinichi Takamoto

Research output: Contribution to journalArticle

4 Citations (Scopus)

Abstract

Bilateral pulmonary artery banding (PAB) has emerged to be an attractive option as an initial procedure for the treatment of hypoplastic left heart syndrome (HLHS), and some centers report excellent survival. However, its usage is variable among institutions and its true efficacy is unknown due to reporting biases. We aimed to describe the results of bilateral PAB use, preoperative risk factors, and long-term outcomes compared with primary Norwood procedure, using a national database. Infants who underwent bilateral PAB or Norwood procedure as an initial palliation for HLHS between January 2008 and December 2012 listed in the Japan Congenital Cardiovascular Surgery Database (JCCVSD) were included. The total number of patients diagnosed with HLHS was 334. Bilateral PABs were performed for 256 patients and primary Norwood procedures for 78 patients, as an initial procedure. Actuarial 5-year survival was 59.0%. The primary Norwood procedure group had better 5-year survival [75.5%; 95% confidence interval (CI) 63.2–84.1] than the bilateral PAB group (75.5 vs. 54.0%, log-rank p < 0.001). However, the bilateral PAB group had more significant risk factors. When the risk-adjusted outcomes were evaluated, there was no significant difference between the primary Norwood group and the bilateral PAB group (76.4 vs. 78.1%, log-rank p = 0.87) in higher volume institutions. The primary Norwood group had better 5-year survival than the bilateral PAB group, but preoperative risk was higher in the bilateral PAB group. Because outcomes are comparable when performed at higher HLHS volume institutions, proper patient selection is important in achieving good long-term result.

Original languageEnglish
Pages (from-to)1-9
Number of pages9
JournalPediatric Cardiology
DOIs
Publication statusAccepted/In press - 2017 Sep 21

Fingerprint

Norwood Procedures
Pulmonary Artery
Hypoplastic Left Heart Syndrome
Survival
Databases
Cardiac Volume
Patient Selection
Japan
Confidence Intervals

Keywords

  • Bilateral pulmonary artery banding
  • Hybrid stage I
  • Hypoplastic left heart syndrome
  • Japan Congenital Heart Surgery Database
  • Norwood operation

ASJC Scopus subject areas

  • Pediatrics, Perinatology, and Child Health
  • Cardiology and Cardiovascular Medicine

Cite this

Long-Term Results of Bilateral Pulmonary Artery Banding Versus Primary Norwood Procedure. / Hirata, Yasutaka; Miyata, Hiroaki; Hirahara, Norimichi; Murakami, Arata; Kado, Hideaki; Sakamoto, Kisaburo; Sano, Shunji; Takamoto, Shinichi.

In: Pediatric Cardiology, 21.09.2017, p. 1-9.

Research output: Contribution to journalArticle

Hirata, Yasutaka ; Miyata, Hiroaki ; Hirahara, Norimichi ; Murakami, Arata ; Kado, Hideaki ; Sakamoto, Kisaburo ; Sano, Shunji ; Takamoto, Shinichi. / Long-Term Results of Bilateral Pulmonary Artery Banding Versus Primary Norwood Procedure. In: Pediatric Cardiology. 2017 ; pp. 1-9.
@article{d8541cd6a31046d889bc920ce4f352f5,
title = "Long-Term Results of Bilateral Pulmonary Artery Banding Versus Primary Norwood Procedure",
abstract = "Bilateral pulmonary artery banding (PAB) has emerged to be an attractive option as an initial procedure for the treatment of hypoplastic left heart syndrome (HLHS), and some centers report excellent survival. However, its usage is variable among institutions and its true efficacy is unknown due to reporting biases. We aimed to describe the results of bilateral PAB use, preoperative risk factors, and long-term outcomes compared with primary Norwood procedure, using a national database. Infants who underwent bilateral PAB or Norwood procedure as an initial palliation for HLHS between January 2008 and December 2012 listed in the Japan Congenital Cardiovascular Surgery Database (JCCVSD) were included. The total number of patients diagnosed with HLHS was 334. Bilateral PABs were performed for 256 patients and primary Norwood procedures for 78 patients, as an initial procedure. Actuarial 5-year survival was 59.0{\%}. The primary Norwood procedure group had better 5-year survival [75.5{\%}; 95{\%} confidence interval (CI) 63.2–84.1] than the bilateral PAB group (75.5 vs. 54.0{\%}, log-rank p < 0.001). However, the bilateral PAB group had more significant risk factors. When the risk-adjusted outcomes were evaluated, there was no significant difference between the primary Norwood group and the bilateral PAB group (76.4 vs. 78.1{\%}, log-rank p = 0.87) in higher volume institutions. The primary Norwood group had better 5-year survival than the bilateral PAB group, but preoperative risk was higher in the bilateral PAB group. Because outcomes are comparable when performed at higher HLHS volume institutions, proper patient selection is important in achieving good long-term result.",
keywords = "Bilateral pulmonary artery banding, Hybrid stage I, Hypoplastic left heart syndrome, Japan Congenital Heart Surgery Database, Norwood operation",
author = "Yasutaka Hirata and Hiroaki Miyata and Norimichi Hirahara and Arata Murakami and Hideaki Kado and Kisaburo Sakamoto and Shunji Sano and Shinichi Takamoto",
year = "2017",
month = "9",
day = "21",
doi = "10.1007/s00246-017-1735-1",
language = "English",
pages = "1--9",
journal = "Pediatric Cardiology",
issn = "0172-0643",
publisher = "Springer New York",

}

TY - JOUR

T1 - Long-Term Results of Bilateral Pulmonary Artery Banding Versus Primary Norwood Procedure

AU - Hirata, Yasutaka

AU - Miyata, Hiroaki

AU - Hirahara, Norimichi

AU - Murakami, Arata

AU - Kado, Hideaki

AU - Sakamoto, Kisaburo

AU - Sano, Shunji

AU - Takamoto, Shinichi

PY - 2017/9/21

Y1 - 2017/9/21

N2 - Bilateral pulmonary artery banding (PAB) has emerged to be an attractive option as an initial procedure for the treatment of hypoplastic left heart syndrome (HLHS), and some centers report excellent survival. However, its usage is variable among institutions and its true efficacy is unknown due to reporting biases. We aimed to describe the results of bilateral PAB use, preoperative risk factors, and long-term outcomes compared with primary Norwood procedure, using a national database. Infants who underwent bilateral PAB or Norwood procedure as an initial palliation for HLHS between January 2008 and December 2012 listed in the Japan Congenital Cardiovascular Surgery Database (JCCVSD) were included. The total number of patients diagnosed with HLHS was 334. Bilateral PABs were performed for 256 patients and primary Norwood procedures for 78 patients, as an initial procedure. Actuarial 5-year survival was 59.0%. The primary Norwood procedure group had better 5-year survival [75.5%; 95% confidence interval (CI) 63.2–84.1] than the bilateral PAB group (75.5 vs. 54.0%, log-rank p < 0.001). However, the bilateral PAB group had more significant risk factors. When the risk-adjusted outcomes were evaluated, there was no significant difference between the primary Norwood group and the bilateral PAB group (76.4 vs. 78.1%, log-rank p = 0.87) in higher volume institutions. The primary Norwood group had better 5-year survival than the bilateral PAB group, but preoperative risk was higher in the bilateral PAB group. Because outcomes are comparable when performed at higher HLHS volume institutions, proper patient selection is important in achieving good long-term result.

AB - Bilateral pulmonary artery banding (PAB) has emerged to be an attractive option as an initial procedure for the treatment of hypoplastic left heart syndrome (HLHS), and some centers report excellent survival. However, its usage is variable among institutions and its true efficacy is unknown due to reporting biases. We aimed to describe the results of bilateral PAB use, preoperative risk factors, and long-term outcomes compared with primary Norwood procedure, using a national database. Infants who underwent bilateral PAB or Norwood procedure as an initial palliation for HLHS between January 2008 and December 2012 listed in the Japan Congenital Cardiovascular Surgery Database (JCCVSD) were included. The total number of patients diagnosed with HLHS was 334. Bilateral PABs were performed for 256 patients and primary Norwood procedures for 78 patients, as an initial procedure. Actuarial 5-year survival was 59.0%. The primary Norwood procedure group had better 5-year survival [75.5%; 95% confidence interval (CI) 63.2–84.1] than the bilateral PAB group (75.5 vs. 54.0%, log-rank p < 0.001). However, the bilateral PAB group had more significant risk factors. When the risk-adjusted outcomes were evaluated, there was no significant difference between the primary Norwood group and the bilateral PAB group (76.4 vs. 78.1%, log-rank p = 0.87) in higher volume institutions. The primary Norwood group had better 5-year survival than the bilateral PAB group, but preoperative risk was higher in the bilateral PAB group. Because outcomes are comparable when performed at higher HLHS volume institutions, proper patient selection is important in achieving good long-term result.

KW - Bilateral pulmonary artery banding

KW - Hybrid stage I

KW - Hypoplastic left heart syndrome

KW - Japan Congenital Heart Surgery Database

KW - Norwood operation

UR - http://www.scopus.com/inward/record.url?scp=85029694137&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=85029694137&partnerID=8YFLogxK

U2 - 10.1007/s00246-017-1735-1

DO - 10.1007/s00246-017-1735-1

M3 - Article

C2 - 28936753

AN - SCOPUS:85029694137

SP - 1

EP - 9

JO - Pediatric Cardiology

JF - Pediatric Cardiology

SN - 0172-0643

ER -