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[Prognostic study of 3 main palliative surgical procedures in patients with single ventricle]
G Trémeau1, A Bozio, F Chapuis
1Service de cardiologie C, Hôpital cardiovasculaire et pneumologique, BP Lyon-Monchat.
Insights
Pulmonary artery banding offers better survival for infants with single ventricle and high pulmonary flow compared to systemic pulmonary shunts. This palliative surgery requires careful patient selection and intensive postoperative care for optimal outcomes.
Area of Science:
- Pediatric Cardiology
- Congenital Heart Disease
- Surgical Interventions
Context:
- Infants with single ventricle and aortic outflow obstruction present complex palliative surgical challenges.
- Palliative procedures like systemic pulmonary shunts, pulmonary artery banding, and aortic arch repair are considered for these critical cases.
Purpose:
- To evaluate the long-term prognosis of three palliative surgical procedures in infants diagnosed with single ventricle and associated anomalies.
- To compare the survival rates of systemic pulmonary shunt, pulmonary artery banding, and aortic arch repair in this patient population.
Summary:
- Pulmonary artery banding demonstrated significantly better survival rates (90% at 1.5 years, 85% at 10 years) compared to systemic pulmonary shunts (63% at 1.5 years, 49% at 10 years).
- Repair of aortic arch anomalies presented a precarious prognosis with survival rates of only 23% at 1.5 years and 16% at 10 years.
- The study included 119 patients who underwent first-intention palliative surgery between 1970 and 1991.
Impact:
- Results suggest pulmonary artery banding is a viable palliative option for single ventricle patients with high pulmonary flow, when carefully selected.
- The findings underscore the importance of intensive postoperative care for successful outcomes in these complex pediatric cardiac surgeries.
Abstract:
In emergency cases of babies with a single ventricle and an obstruction to aortic outflow, low pulmonary flow or, on the contrary, high pulmonary flow, only palliative surgical procedures can be proposed. The authors set out to determine the prognosis of a population with this type of lesion having undergone one of the three following procedures: systemic pulmonary shunt, pulmonary artery banding, repair of the aortic arch (usually associated with pulmonary banding). One hundred and nineteen (63%) of the 185 patients hospitalised between 1/01/1970 and 31/12/1991 in the paediatric cardiology unit of the Cardiac Hospital of Lyon with a diagnosis of single ventricle, underwent one of these three procedures as a treatment of first intention. The survival of the 22 patients who underwent pulmonary artery banding (90 +/- 6%, 85 +/- 8%, 85 +/- 8% at 1.5 and 10 years respectively) was significantly better than that of the patients undergoing systemico-pulmonary shunt (63 +/- 6%, 53 +/- 6% and 49 +/- 6% at 1.5 and 10 years respectively). On the other hand, repair of an obstacle of the aortic arch was a precarious procedure as the survival was only 23 +/- 11%, 16 +/- 11% and 16 +/- 11% and 1.5 and 10 years respectively). These results suggest, with the reserve inherent to the methodology of retrospective studies of small populations, that it is not illogical to continue to propose pulmonary artery banding for babies with single ventricle associated with high pulmonary flow. This procedure should only be envisaged after strict selection of candidates and providing there are facilities for intensive postoperative care.(ABSTRACT TRUNCATED AT 250 WORDS)