110-IPULMONARY ARTERY SLING REPAIR: SINGLE-CENTRE EXPERIENCE WITH ANALYSIS OF RISK FACTORS

• Published in: Interactive cardiovascular and thoracic surgery Vol. 19; no. suppl_1; p. S34
• Main Authors: Muthialu, N., Bezuska, L., Nakao, M., Elliott, M.J., Tsang, V.
• Format: Journal Article
• Language: English
• Published: Oxford University Press 01-10-2014
• ISSN: 1569-9293; 1569-9285
• DOI: 10.1093/icvts/ivu276.110

Objectives: Pulmonary artery (PA) sling is a rare vascular anomaly often associated with tracheal stenosis or intracardiac anomalies. Surgical repair is standardised but coexistent anomalies often determine outcomes. There is a paucity of risk stratification and correlation with coexistent hypoplasia of the lung. The aim of our study is to stratify risk factors for the surgical outcome of complex pulmonary artery sling repair.
Methods: Forty-eight children (median age 5 months; IQR 3–9.1) with PA sling after repair through median sternotomy (43/48) or left thoracotomy (5/48) were evaluated retrospectively. Four (8.3%) had hypoplastic right lung and 1 had right lung agenesis. Thirty-seven (77.1%) underwent slide tracheoplasty; structural heart lesions were repaired in 9 (3 tetralogy of Fallot, 1 aorto-pulmonary window, 1 atrial septal defect repair, and 5 ventricular septal defect repair). Ten children underwent isolated PA sling repair.
Results: There were 4 early deaths. Two patients needed revision of anastomosis. The median ICU and hospital stay were 17.9 (9.2–24.8) and 11 (4.3–19.8) days. Follow-up was complete in 39 out of 41. Three (6.8%) children died late (at 2.7, 10.2 and 17 months). Univariate analysis showed abnormal lung (hypoplasia or agenesis) and structural heart disease as risk factors (P = 0.038 and 0.001). Multivariate analysis revealed cardiopulmonary bypass (CPB) time as an independent predictor for mortality (P = 0.039).
Conclusion: Single stage complex pulmonary artery sling repair can be performed with good surgical outcome even when associated with airway malformations or structural heart diseases. Lung abnormality and longer CPB time, as a surrogate marker for prolonged or complex surgery, are possible risk factors.