Hostname: page-component-7c8c6479df-nwzlb Total loading time: 0 Render date: 2024-03-27T14:44:25.174Z Has data issue: false hasContentIssue false

Pulmonary artery banding: still a role for staged bi-ventricular repair of intracardiac shunts?

Published online by Cambridge University Press:  14 September 2022

Ahmed R. S. A. Afifi*
Affiliation:
Department of Cardiology, Birmingham Women’s and Children’s NHS Foundation Trust, Birmingham B4 6NH, UK Department of Pediatrics, Faculty of Medicine, Benha University, Benha 13512, Egypt
Anna N. Seale
Affiliation:
Department of Cardiology, Birmingham Women’s and Children’s NHS Foundation Trust, Birmingham B4 6NH, UK
Milind Chaudhari
Affiliation:
Department of Cardiology, Birmingham Women’s and Children’s NHS Foundation Trust, Birmingham B4 6NH, UK
Natasha E. Khan
Affiliation:
Department of Cardiac Surgery, Birmingham Women’s and Children’s NHS Foundation Trust, Birmingham B4 6NH, UK
Timothy J. Jones
Affiliation:
Department of Cardiac Surgery, Birmingham Women’s and Children’s NHS Foundation Trust, Birmingham B4 6NH, UK
Oliver Stumper
Affiliation:
Department of Cardiology, Birmingham Women’s and Children’s NHS Foundation Trust, Birmingham B4 6NH, UK
Phil Botha
Affiliation:
Department of Cardiac Surgery, Birmingham Women’s and Children’s NHS Foundation Trust, Birmingham B4 6NH, UK
*
Author for correspondence: Dr Ahmed RSA Afifi, Department of Cardiology, Birmingham Children’s Hospital, Steelhouse Lane, Birmingham B4 6NH, United Kingdom. Tel: +44 07407230584. E-mail: Ahmed.sanad86@fmed.bu.edu.eg

Abstract

Objectives:

Although pulmonary artery banding remains a useful palliation in bi-ventricular shunting lesions, single-stage repair holds several advantages. We investigate outcomes of the former approach in high-risk patients.

Methods:

Retrospective cohort study including all pulmonary artery banding procedures over 9 years, excluding single ventricle physiology and left ventricular training.

Results:

Banding was performed in 125 patients at a median age of 41 days (2–294) and weight of 3.4 kg (1.8–7.32). Staged repair was undertaken for significant co-morbidity in 81 (64.8%) and anatomical complexity in 44 (35.2%). The median hospital stay was 14 days (interquartile range 8–33.5) and 14 patients (11.2%) required anatomical repair before discharge. Nine patients died during the initial admission (hospital mortality 7.2 %) and five following discharge (inter-stage mortality 4.8%). Of 105 banded patients who survived, 19 (18.1%) needed inter-stage re-admission and 18 (14.4%) required unplanned re-intervention. Full repair was performed in 93 (74.4%) at a median age of 13 months (3.1–49.9) and weight of 8.5 kg (3.08–16.8). Prior banding, 54% were below the 0.4th weight centile, but only 28% remained so at repair. Post-repair, 5/93 (5.4%) developed heart block requiring permanent pacemaker, and 11/93 (11.8%) required unplanned re-intervention. The post-repair mortality (including repairs during the initial admission) was 6/93 (6.5%), with overall mortality of the staged approach 13.6% (17/125).

Conclusions:

In a cohort with a high incidence of co-morbidity, pulmonary artery banding is associated with a significant risk of re-intervention and mortality. Weight gain improves after banding, but heart block, re-intervention, and mortality remain frequent following repair.

Type
Original Article
Copyright
© The Author(s), 2022. Published by Cambridge University Press

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

Footnotes

Presented as a poster presentation at the digital AEPC congress 2021. The study was approved by the Institutional clinical audit department (Reference: 30519).

References

Muller, WH Jr, Dammann, JF. The treatment of certain malformations of the heart by the creation of pulmonic stenosis to reduce pulmonary hypertension and excessive pulmonary blood flow: a preliminary report. Surg Gynecol Obstet 1952; 95: 213219.Google ScholarPubMed
Alsoufi, B. Commentary: pulmonary artery banding in infants with atrioventricular septal defect, valid strategy or backward move? J Thorac Cardiovasc Surg, Apr 2020; 159: 15041506.10.1016/j.jtcvs.2019.10.013CrossRefGoogle ScholarPubMed
Nagashima, M, Okamura, T, Shikata, F, et al. Pulmonary artery banding for neonates and early infants with low body weight. Tohoku J Exp Med 2011 Dec; 225: 255262.10.1620/tjem.225.255CrossRefGoogle ScholarPubMed
Buratto, E, Hu, T, Lui, A, et al. Early repair of complete atrioventricular septal defect has better survival than staged repair after pulmonary artery banding: a propensity score-matched study. J Thorac Cardiovasc Surg 2021 May; 161: 15941601.10.1016/j.jtcvs.2020.07.106CrossRefGoogle ScholarPubMed
Takayama, H, Sekiguchi, A, Chikada, M, Noma, M, Ishizawa, A, Takamoto, S. Mortality of pulmonary artery banding in the current era: recent mortality of PA banding. Ann Thorac Surg 2002 Oct; 74: 121923; discussion 1223-4.10.1016/S0003-4975(02)03900-0CrossRefGoogle ScholarPubMed
Inohara, T, Ichihara, N, Kohsaka, S, et al. The effect of body weight in infants undergoing ventricular septal defect closure: a report from the Nationwide Japanese Congenital Surgical Database. J Thorac Cardiovasc Surg 2019 Mar; 157: 11321141.e7.10.1016/j.jtcvs.2018.11.111CrossRefGoogle ScholarPubMed
Atz, AM, Hawkins, JA, Lu, M, et al. Surgical management of complete atrioventricular septal defect: associations with surgical technique, age, and trisomy 21. J Thorac Cardiovasc Surg 2011; 141: 13711379.10.1016/j.jtcvs.2010.08.093CrossRefGoogle ScholarPubMed
Brooks, A, Geldenhuys, A, Zuhlke, L, Human, P, Zilla, P. Pulmonary artery banding: still a valuable option in developing countries? Eur J Cardiothorac Surg 2012 Feb; 41: 272276.10.1016/j.ejcts.2011.05.053CrossRefGoogle Scholar
Trusler, GA, Mustard, WT. A method of banding the pulmonary artery for large isolated ventricular septal defect with and without transposition of the great arteries. Ann Thorac Surg 1972; 13: 351355.10.1016/S0003-4975(10)64866-7CrossRefGoogle ScholarPubMed
Lin, A, Mahle, WT, Frias, PA, et al. Early and delayed atrioventricular conduction block after routine surgery for congenital heart disease. J Thorac Cardiovasc Surg 2010 Jul; 140: 158160.10.1016/j.jtcvs.2009.12.050CrossRefGoogle ScholarPubMed
Loomba, RS, Flores, S, Villarreal, EG, Bronicki, RA, Anderson, RH. Modified single-patch versus two-patch repair for atrioventricular septal defect: a systematic review and meta-analysis. World J Pediatr Congenit Heart Surg 2019 Sep; 10: 616623.10.1177/2150135119859882CrossRefGoogle ScholarPubMed
Vohra, HA, Chia, AX, Yuen, HM, et al. Primary biventricular repair of atrioventricular septal defects: an analysis of reoperations. Ann Thorac Surg 2010 Sep; 90: 830837.10.1016/j.athoracsur.2010.03.108CrossRefGoogle ScholarPubMed
Daley, M, Brizard, CP, Konstantinov, IE, et al. Outcomes of patients undergoing surgical management of multiple ventricular septal defects. Semin Thorac Cardiovasc Surg 2019 Spring; 31: 8996.10.1053/j.semtcvs.2018.03.006CrossRefGoogle ScholarPubMed
St Louis, JD, Jodhka, U, Jacobs, JP, et al. Contemporary outcomes of complete atrioventricular septal defect repair: analysis of the Society of Thoracic Surgeons Congenital Heart Surgery Database. J Thorac Cardiovasc Surg 2014 Dec; 148: 25262531.10.1016/j.jtcvs.2014.05.095CrossRefGoogle Scholar
Alsoufi, B, Manlhiot, C, Ehrlich, A, et al. Results of palliation with an initial pulmonary artery band in patients with single ventricle associated with unrestricted pulmonary blood flow. J Thorac Cardiovasc Surg 2015 Jan; 149: 213220.10.1016/j.jtcvs.2014.08.007CrossRefGoogle ScholarPubMed
Supplementary material: File

Afifi et al. supplementary material

Afifi et al. supplementary material 1
Download Afifi et al. supplementary material(File)
File 17.4 KB
Supplementary material: File

Afifi et al. supplementary material

Afifi et al. supplementary material 2

Download Afifi et al. supplementary material(File)
File 86.1 KB
Supplementary material: File

Afifi et al. supplementary material

Afifi et al. supplementary material 3

Download Afifi et al. supplementary material(File)
File 564.8 KB