Open Access

ARTICLE

Association of Time Interval between Pulmonary Artery Banding and Bidirectional Cavopulmonary Shunt on Postoperative Outcomes in Univentricular Heart Defect

Budi Rahmat¹, Dicky Fakhri¹, Rama Vinnu Isyawan¹, Ghitha Zahra Haifa^1,2,*

1 Pediatric and Congenital Heart Surgery Division, National Cardiovascular Centre, Harapan Kita, Jakarta, Indonesia
2 Cardiac, Thoracic and Vascular Surgery Training Program, Department of Surgery, Faculty of Medicine, University of Indonesia, Jakarta, Indonesia

* Corresponding Author: Ghitha Zahra Haifa. Email:

(This article belongs to the Special Issue: Special Issue from the 5^th Asian Association for Pediatric and Congenital Heart Surgery (AAPCHS) Annual Conference)

Structural and Congenital Heart Disease 2026, 21(3), 4 https://doi.org/10.32604/schd.2026.077573

Received 12 December 2025; Accepted 15 July 2026; Issue published 31 July 2026

Abstract

Background: Univentricular heart defects with unrestricted pulmonary blood flow are commonly managed using pulmonary artery banding (PAB) followed by bidirectional cavopulmonary shunt (BCPS) as part of staged palliation, but the optimal interval between these procedures remains uncertain. Methods: This retrospective cohort study evaluated the association between the PAB–BCPS interval and postoperative outcomes after BCPS in patients treated at the National Cardiovascular Center Harapan Kita, Indonesia, from January 2015 to January 2024. Patients with univentricular heart defects and unrestricted pulmonary blood flow who underwent BCPS after prior PAB were included, whereas those undergoing BCPS with major concomitant procedures were excluded. Patients were stratified into <24-month and ≥24-month PAB–BCPS interval groups using a pragmatic median-based cut-off that provided reasonably balanced groups. Outcomes included early mortality, one-year mortality, ventilator duration, intensive care unit length of stay, and postoperative hospital length of stay. Results: A total of 41 patients were included, with a median PAB–BCPS interval of 26 months. Early mortality occurred in 2 patients (4.9%), both in the <24-month group, whereas no early mortality occurred in the ≥24-month group; however, this difference was not statistically significant [2/19 (10.5%) vs. 0/22 (0%); p = 0.209]. One-year mortality was also not significantly different between groups [5/19 (26.3%) vs. 3/22 (13.6%); p = 0.436]. Ventilator duration, intensive care unit length of stay, and postoperative hospital length of stay were comparable between groups. Exploratory Firth’s penalized logistic regression suggested that a longer PAB–BCPS interval was associated with lower odds of early mortality, but this finding should be interpreted cautiously because only two early mortality events occurred. Linear regression analysis showed that the PAB–BCPS interval was not significantly associated with ventilator duration, intensive care unit length of stay, or hospital length of stay. Higher preoperative mean pulmonary artery pressure was significantly associated with longer ventilator duration and intensive care unit stay. Conclusions: These findings suggest that hemodynamic readiness may be more clinically relevant than interval duration alone when determining suitability for BCPS after PAB. Larger multicenter studies are needed to validate these hypothesis-generating findings.

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