Abstract
A hybrid procedure combining bilateral pulmonary artery banding with ductal stenting has recently been used as stage I palliation for hypoplastic left heart syndrome. However, the advantage of the hybrid procedure over the Norwood procedure on ventricular energetics remains unclear. To clarify this, we performed a computational analysis with a combination of time-varying elastance chamber model and modified three-element Windkessel vascular model. Although mean pulmonary artery (PA) pressure, pulmonary flow, and oxygen saturation were almost equivalent with the Norwood procedure, the hybrid procedure delivered higher systolic and lower diastolic systemic arterial pressures compared to the Norwood procedure with right ventricle (RV) to PA shunt. As a result, the hybrid procedure yielded increased systolic pressure–volume area and impaired mechanical efficiency. Therefore, the hybrid procedure has probably no advantage on ventricular energetics compared to the Norwood procedure with a RV-PA shunt.
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References
Gibbs JL, Wren C, Watterson KG, Hunter S, Hamilton JR (1993) Stenting of the arterial duct combined with banding of the pulmonary arteries and atrial septectomy or septostomy: a new approach to palliation for the hypoplastic left heart syndrome. Br Heart J 69:551–555
Venugopal PS, Luna KP, Anderson DR, Austin CB, Rosenthal E, Krasemann T, Qureshi SA (2010) Hybrid procedure as an alternative to surgical palliation of high-risk infants with hypoplastic left heart syndrome and its variants. J Thorac Cardiovasc Surg 139:1211–1215
Caldarone CA, Benson L, Holtby H, Li J, Redington AN, Van Arsdell GS (2007) Initial experience with hybrid palliation for neonates with single-ventricle physiology. Ann Thorac Surg 84:1294–1300
Galantowicz M, Cheatham JP, Phillips A, Cua CL, Hoffman TM, Hill SL, Rodeman R (2008) Hybrid approach for hypoplastic left heart syndrome: intermediate results after the learning curve. Ann Thorac Surg 85:2063–2070
Photiadis J, Sinzobahamvya N, Hraška V, Asfour B (2012) Does bilateral pulmonary banding in comparison to Norwood procedure improve outcome in neonates with hypoplastic left heart syndrome beyond second-stage palliation? A review of the current literature. Thorac Cardiovasc Surg 60:181–188
Sasaki T, Takahashi Y, Ando M, Wada N, Kawase Y, Seki H (2008) Bilateral pulmonary artery banding for hypoplastic left heart syndrome and related anomalies. General Thorac Cardiovasc Surg 56:158–162
Sano S, Ishino K, Kawada M, Arai S, Kasahara S, Asai T, Masuda Z, Takeuchi M, Ohtsuki S (2003) Right ventricle-pulmonary artery shunt in first-stage palliation of hypoplastic left heart syndrome. J Thorac Cardiovasc Surg 126:504–509
Sharma V, Deo SV, Huebner M, Dearani JA, Burkhart HM (2014) In search of the ideal pulmonary blood source for the Norwood procedure: a meta-analysis and systematic review. Ann Thorac Surg 98:142–150
Lee N, Das A, Banerjee RK, Gottliebson WM (2013) Comparison of stroke work between repaired tetralogy of Fallot and normal right ventricular physiologies. Heart Vessels 28:76–85
Bove EL, Migliavacca F, de Leval MR, Balossino R, Pennati G, Lloyd TR, Khambadkone S, Hsia TY, Dubini G (2008) Use of mathematic modeling to compare and predict hemodynamic effects of the modified Blalock–Taussig and right ventricle-pulmonary artery shunts for hypoplastic left heart syndrome. J Thorac Cardiovasc Surg 136:312–320
Shimizu S, Une D, Shishido T, Kamiya A, Kawada T, Sano S, Sugimachi M (2011) Norwood procedure with non-valved right ventricle to pulmonary artery shunt improves ventricular energetics despite the presence of diastolic regurgitation: a theoretical analysis. J Physiol Sci 61:457–465
Li J, Zhang G, Benson L, Holtby H, Cai S, Humpl T, Van Arsdell GS, Redington AN, Caldarone CA (2007) Comparison of the profiles of postoperative systemic hemodynamics and oxygen transport in neonates after the hybrid or the Norwood procedure: a pilot study. Circulation 116(Suppl):I179–I187
Burkhoff D, Tyberg JV (1993) Why does pulmonary venous pressure rise after onset of LV dysfunction: a theoretical analysis. Am J Physiol 265:H1819–H1828
Morley D, Litwak K, Ferber P, Spence P, Dowling R, Meyns B, Griffith B, Burkhoff D (2007) Hemodynamic effects of partial ventricular support in chronic heart failure: results of simulation validated with in vivo data. J Thorac Cardiovasc Surg 133:21–28
Shimizu S, Shishido T, Une D, Kamiya A, Kawada T, Sano S, Sugimachi M (2010) Right ventricular stiffness constant as a predictor of postoperative hemodynamics in patients with hypoplastic right ventricle: a theoretical analysis. J Physiol Sci 60:205–212
Migliavacca F, Pennati G, Dubini G, Fumero R, Pietrabissa R, Urcelay G, Bove EL, Hsia TY, de Leval MR (2001) Modeling of the Norwood circulation: effects of shunt size, vascular resistances, and heart rate. Am J Physiol Heart Circ Physiol 280:H2076–H2086
Chang AC, Kulik TJ, Hickey PR, Wessel DL (1993) Real-time gas-exchange measurement of oxygen consumption in neonates and infants after cardiac surgery. Crit Care Med 21:1369–1375
Curzon CL, Milford-Beland S, Li JS, O’Brien SM, Jacobs JP, Jacobs ML, Welke KF, Lodge AJ, Peterson ED, Jaggers J (2008) Cardiac surgery in infants with low birth weight is associated with increased mortality: analysis of the Society of Thoracic Surgeons Congenital Heart Database. J Thorac Cardiovasc Surg 135:546–551
Sano S, Huang SC, Kasahara S, Yoshizumi K, Kotani Y, Ishino K (2009) Risk factors for mortality after the Norwood procedure using right ventricle to pulmonary artery shunt. Ann Thorac Surg 87:178–185
Shepard CW, Kochilas LK, Rosengart RM, Brearley AM, Bryant R 3rd, Moller JH, St Louis JD (2010) Repair of major congenital cardiac defects in low-birth-weight infants: is delay warranted? J Thorac Cardiovasc Surg 140:1104–1109
Pawade A, Waterson K, Laussen P, Karl TR, Mee RB (1993) Cardiopulmonary bypass in neonates weighing less than 2.5 kg: analysis of the risk factors for early and late mortality. J Card Surg 8:1–8
Weinstein S, Gaynor JW, Bridges ND, Wernovsky G, Montenegro LM, Godinez RI, Spray TL (1999) Early survival of infants weighing 2.5 kilograms or less undergoing first-stage reconstruction for hypoplastic left heart syndrome. Circulation 100(Suppl):II167–II170
Pizarro C, Derby CD, Baffa JM, Murdison KA, Radtke WA (2008) Improving the outcome of high-risk neonates with hypoplastic left heart syndrome: hybrid procedure or conventional surgical palliation? Eur J Cardiothorac Surg 33:613–618
Tune JD, Gorman MW, Feigl EO (2004) Matching coronary blood flow to myocardial oxygen consumption. J Appl Physiol 97:404–415
Sughimoto K, Takahara Y, Mogi K, Yamazaki K, Tsubota K, Liang F, Liu H (2014) Blood flow dynamic improvement with aneurysm repair detected by a patient-specific model of multiple aortic aneurysms. Heart Vessels 29:404–412
Acknowledgments
The present study was supported by a research project promoted by the Japanese Ministry of Health, Labour and Welfare (H20-katsudo-Shitei-007) and Grants-in-Aid for Scientific Research (No. 22791328) from the Ministry of Education, Culture, Sports, Science and Technology.
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The authors declare that they have no conflict of interest.
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Because this study is a simulation study, the declaration about ethics does not apply to this study.
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Shimizu, S., Kawada, T., Une, D. et al. Hybrid stage I palliation for hypoplastic left heart syndrome has no advantage on ventricular energetics: a theoretical analysis. Heart Vessels 31, 105–113 (2016). https://doi.org/10.1007/s00380-014-0604-6
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DOI: https://doi.org/10.1007/s00380-014-0604-6