Intention-to-treat analysis of pulmonary artery banding in conditions with a morphological right ventricle in the systemic circulation with a view to anatomic biventricular repair.
BACKGROUND
Some patients with a morphological right ventricle (mRV) in the systemic circulation require early intervention because of progressive systemic ventricular dysfunction or atrioventricular valve regurgitation. They may be eligible for anatomic repair (correction of atrioventricular and ventriculoarterial discordance) but require prior training of the morphological left ventricle (mLV).


RESULTS
Forty-one patients with congenitally corrected transposition of the great arteries or a previous atrial switch procedure embarked on a protocol of pulmonary artery (PA) banding with a view to anatomic repair. All had an mRV in the systemic circulation and a subpulmonary mLV that was not conditioned by either volume or pressure load. Two patients were not banded, and 39 were followed up for a median of 4.3 years (range, 25 days to 12.6 years). Sixteen patients achieved anatomic repair, with 3 in the early stages of the training protocol. After 2 years, 12 patients were not suitable for anatomic repair and persisted with palliative banding; 8 were functionally improved; and 4 died, underwent transplantation, or required debanding. PA banding improved functional class but did not improve tricuspid regurgitation in the long term for patients not achieving anatomic repair. mLV function was a critical determinant of survival with a PA band as well as survival after anatomic repair. Patients >16 years were unlikely to achieve anatomic repair.


CONCLUSIONS
PA banding is a safe and effective method of training the mLV before anatomic repair. It is also an effective palliative procedure for those who do not attain this goal.
Winlaw
David S
DS
Diana, Princess of Wales Children's Hospital, Birmingham Children's Hospital NHS Trust, Birmingham, England. davidw@chw.edu.au
McGuirk
Simon P
SP
Balmer
Christian
C
Langley
Stephen M
SM
Griselli
Massimo
M
Stümper
Oliver
O
De Giovanni
Joseph V
JV
Wright
John G
JG
Thorne
Sara
S
Barron
David J
DJ
Brawn
William J
WJ
D000293:Adolescent; D000328:Adult; D002648:Child; D018572:Disease-Free Survival; D005260:Female; D005500:Follow-Up Studies; D006333:Heart Failure / Q000209:etiology / Q000401:mortality / Q000517:prevention & control; D006345:Heart Septal Defects, Ventricular / Q000601:surgery; D006352:Heart Ventricles / Q000503:physiopathology* / Q000601:surgery; D018056:Hemorheology; D006801:Humans; D015993:Life Tables; D008026:Ligation; D008297:Male; D010166:Palliative Care; D011183:Postoperative Complications / Q000401:mortality / Q000601:surgery*; D011312:Pressure; D011651:Pulmonary Artery / Q000601:surgery*; D014188:Transposition of Great Vessels / Q000601:surgery; D016896:Treatment Outcome; D014261:Tricuspid Valve / Q000503:physiopathology; D014262:Tricuspid Valve Insufficiency / Q000601:surgery