초록접수 현황
| 15F-171 | 구연 발표 |
Bilateral Pulmonary Artery Banding as a Salvage Procedure for Complex Congenital Heart Defects other than Hypoplastic Left Heart Syndrome
방지현, 박천수, 박정준, 윤태진
울산대학교 의과대학 서울아산병원 흉부외과학교실 소아심장외과
Background : Bilateral pulmonary artery banding (b-PAB) with or without ductal stent has been performed as a rescue therapy for critically ill babies with complex congenital heart defects. We sought to explore the perioperative risk factors for unfavorable outcome after b-PAB.
Methods : From 2005 to 2015, 36 consecutive patients (16 males, median age: 13 days, range: 2-78 days; a median body weight of 2.69kg, range, 1.3-3.63 kg) with various complex heart anomalies underwent b-PAB. The cardiac diagnoses included variant hypoplastic left heart complex in 17, left ventricular outflow tract obstruction with arch obstruction in 6, truncus arteiosus in 4, unbalanced atrioventricular canal in 2, tricuspid atresia (IIc) in 2, and double inlet left ventricle with the transposition of the great arteries in 2. Risk factors precluding the patients from undergoing conventional palliation using cardiopulmonary bypass are as follows: preterm birth (<36 weeks) (n=14), low birth weight (<2.5 kg) (n=16), preoperative shock (n=4), preoperative atrioventricular valvar regurgitation (n=31) and preoperative intracerebral hemorrhage (n=8). Ductal patency was maintained by ductal stenting (n=18) or by administering prostaglandin E1 (n= 17) In one patient with truncus arteriosus, ductus was ligated.
Results : Hospital mortality was 33% (12/36), and twenty-four patients (66.7%) who survived to discharge had undergone biventricular repair (n=5), bidirectional cavopulmonary shunt (n =8) and interstage (n=11). Follow-up was complete in 94.4 % of the patients. During a mean follow-up duration of 162 days (range, 1-3551 days), there were 7 late deaths (5 during interstage, 2 after bidirectional cavopulmonary shunt). The final states of the patients are biventricular repair in 5, post-bidirectional cavopulmonary shunt in 2, post-Fontan operation in 4, and post-b-PAB in 6. One and three-year survival after births was 53.3% and 49.5% respectively.
On logistic regression analysis, lower birth weight (p=0.04) and lower gestational age (p=0.05) were identified as independent risk factors for early mortality.
Conclusion : Bilateral pulmonary artery banding was a safe and effective in resuscitation and allowance for next stage operation in high risk neonates and young infants.
Methods : From 2005 to 2015, 36 consecutive patients (16 males, median age: 13 days, range: 2-78 days; a median body weight of 2.69kg, range, 1.3-3.63 kg) with various complex heart anomalies underwent b-PAB. The cardiac diagnoses included variant hypoplastic left heart complex in 17, left ventricular outflow tract obstruction with arch obstruction in 6, truncus arteiosus in 4, unbalanced atrioventricular canal in 2, tricuspid atresia (IIc) in 2, and double inlet left ventricle with the transposition of the great arteries in 2. Risk factors precluding the patients from undergoing conventional palliation using cardiopulmonary bypass are as follows: preterm birth (<36 weeks) (n=14), low birth weight (<2.5 kg) (n=16), preoperative shock (n=4), preoperative atrioventricular valvar regurgitation (n=31) and preoperative intracerebral hemorrhage (n=8). Ductal patency was maintained by ductal stenting (n=18) or by administering prostaglandin E1 (n= 17) In one patient with truncus arteriosus, ductus was ligated.
Results : Hospital mortality was 33% (12/36), and twenty-four patients (66.7%) who survived to discharge had undergone biventricular repair (n=5), bidirectional cavopulmonary shunt (n =8) and interstage (n=11). Follow-up was complete in 94.4 % of the patients. During a mean follow-up duration of 162 days (range, 1-3551 days), there were 7 late deaths (5 during interstage, 2 after bidirectional cavopulmonary shunt). The final states of the patients are biventricular repair in 5, post-bidirectional cavopulmonary shunt in 2, post-Fontan operation in 4, and post-b-PAB in 6. One and three-year survival after births was 53.3% and 49.5% respectively.
On logistic regression analysis, lower birth weight (p=0.04) and lower gestational age (p=0.05) were identified as independent risk factors for early mortality.
Conclusion : Bilateral pulmonary artery banding was a safe and effective in resuscitation and allowance for next stage operation in high risk neonates and young infants.
책임저자: 윤태진
울산대학교 의과대학 서울아산병원 흉부외과학교실 소아심장외과
연락처 : 방지현, Tel: 010-2643-5777 , E-mail : mibbi@naver.com
