Association of Intraoperative PaCO₂-EtCO₂ Gradient With Need for Pulmonary Blood Flow Reconditioning After Bilateral Pulmonary Artery Banding in Hypoplastic Left Heart Syndrome.

Authors

Mariko Tanaka-Ishikawa, Kaoru Izumi, Keiichiro Mizuno, Ken Yamaura

Published in

Journal of cardiothoracic and vascular anesthesia. Aug 16, 2026. Epub Aug 16, 2026.

Abstract

To investigate the association between the intraoperative arterial to end-tidal carbon dioxide (PaCO₂-EtCO₂) gradient and the need for urgent pulmonary blood flow reconditioning after bilateral pulmonary artery banding (bPAB) in neonates with hypoplastic left heart syndrome (HLHS).
Retrospective observational study.
Single-center, tertiary referral center for congenital heart disease.
Thirty-nine neonates with HLHS underwent bPAB between 2018 and 2023.
No intervention was performed. Patients were categorized into 3 groups based on postoperative management: a control group without reconditioning (n = 30), an excessive banding group requiring band loosening (n = 5), and a loose banding group requiring band tightening (n = 4).
The PaCO₂-EtCO₂ gradient and EtCO₂/PaCO₂ ratio were measured intraoperatively and compared among groups. The gradient increased significantly after bPAB in the excessive banding group (6.6 ± 2.5 to 13.9 ± 3.3 mmHg, p < 0.05), with a similar but nonsignificant increase in the loose banding group. After sternal closure, both reconditioning groups showed higher gradients compared with controls. Exploratory receiver operating characteristic analysis demonstrated an area under the curve of 0.906 (cutoff, 8.8 mmHg) for the PaCO₂-EtCO₂ gradient and 0.915 (cutoff, 0.792) for the EtCO₂/PaCO₂ ratio in relation to subsequent urgent pulmonary blood flow reconditioning.
The intraoperative PaCO₂-EtCO₂ gradient was associated with the subsequent need for urgent pulmonary blood flow reconditioning after bPAB in neonates with HLHS.

PMID:
42705937
Bibliographic data and abstract were imported from PubMed on 08 Sep 2026.

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