Bilateral Pulmonary Artery Banding ± Ductal Stenting (Hybrid Palliation) for Infants With Critical Left Heart Obstruction: A Multi-Institutional Outcomes Analysis

Abstract

Bilateral pulmonary artery banding ± ductal stenting (hybrid palliation) is an established initial management option for infants with critical left heart obstruction. We determined patient/procedural characteristics, subsequent outcomes, and associated factors for 214 infants who underwent hybrid palliation from 2005-2019 across 24 institutions. Parametric multivariable hazard modeling with competing risk methodology was performed to determine risk and factors associated with the various endpoints. At 5 years, 9% had biventricular repair, 36% had Fontan, 12% had transplantation, 35% died, and 8% were alive without an endpoint. High-risk patient characteristics and anatomic factors relevant to critical left heart obstruction were associated with mortality and/or achieved surgical pathway. Procedural and interstage mortality are high after initial hybrid palliation. Nonetheless, hybrid palliation may be used as a strategy both to facilitate biventricular repair for some infants, and for others, as stabilization for intended functional univentricular palliation or primary transplantation.