The outcome of pulmonary artery banding as used in a staged approach to defer primary definitive biventricular repair in perceived high-risk cases

  • Dr Andre Brooks, Christiaan Barnard Department of Cardiothoracic Surgery, University of Cape Town, Red Cross Children’s Hospital, South Africa
  • Dr Agnetha Geldenhuys, Christiaan Barnard Department of Cardiothoracic Surgery, University of Cape Town, Red Cross Children’s Hospital, South Africa
  • Dr Paul Human, Christiaan Barnard Department of Cardiothoracic Surgery, University of Cape Town, South Africa
  • Dr Liesl Zuhlke, Department of Paediatric Cardiology, University of Cape Town, Red Cross Children’s Hospital, South Africa

    • Objective
    Intra-cardiac defects causing large left-right shunts may lead to severely ill patients with potential high risk for cardiopulmonary bypass and definitive repair. We test the hypothesis that surgical risk may be lowered by a staged approach when a pulmonary artery band (PAB) is first applied.

    Method
    A retrospective review of all PAB operations done at our institution between January 2002 and December 2007 was done. Data was analyzed further if the aim was to later achieve a bi-ventricular repair.

    Results
    Of the 187 files that were reviewed 144 had a PAB with a view to later achieve a bi-ventricular repair(30 excluded due to uni-ventricular pathway,13 files lost). Of these (N=144) the total mortality, defined as all cause mortality until the time of definitive repair, was 24%(N=35). The in-hospital mortality was 8%(N =12) and the inter-stage mortality was an additional 16%(N=23). In the majority positive growth was not documented following PAB application. The mean weight at PA banding was 5±3kg (range, 1.8 to 25kg). The mean time interval between PA banding and definitive repair was 22±13 months. The mean ICU stay at PAB was 7±15 days with a mean hospital stay of 21±34days.
    Conclusion
    Despite an acceptable in-hospital mortality, the practice of deferring bi-ventricular repair by the application of a pulmonary artery band carries such a high total mortality that consideration should be given to early definitive repair even in perceived high risk cases.