Endoluminal pulmonary artery banding: technique, applications and results.
BACKGROUND
Occasionally pulmonary artery banding is necessary to reduce pulmonary arterial blood flow and pressure in patients who cannot be repaired in a single stage. Traditional extraluminal PAB can be associated with significant morbidity. We describe our technique, applications, and results of endoluminal pulmonary artery banding (EPAB) with and without creation of an aortopulmonary window (APW) for complex cardiac anomalies.


METHODS
Thirty-two patients underwent EPAB; 20 patients had simultaneous creation of an APW. Median patient age was 40 days (range, 2 to 3,210); median weight was 3.5 kg (range, 2.4 to 23 kg). Endoluminal pulmonary artery banding fenestrations of 2 to 8 mm were centrally placed in a Dacron patch that was attached circumferentially and intraluminally in the main pulmonary artery. Fenestrations were sized by presence of APW and patient weight. Thirty-one of 32 patients underwent associated cardiac procedures. The mean follow-up period was 2.6 years (range, 0 to 15.5).


RESULTS
Overall early mortality was 31% (10 of 32); 8% in EPAB alone (1 of 12) and 45% for EPAB+APW (9 of 20). Of the early deaths, 7 of 10 had severe, preoperative ventricular dysfunction. There was 1 early EPAB-related complication requiring band revision for relief of partial obstruction of the APW. At hospital dismissal, the mean pressure gradient after EPAB was 55.1 +/- 8.4 mm Hg as assessed by echocardiography. No patient experienced distal pulmonary hypertension, distortion, or band occlusion. There were 6 late deaths. At late follow-up, 5 patients underwent band revision, and complete repair was accomplished in 10 patients.


CONCLUSIONS
Endoluminal pulmonary artery banding provided a consistently effective and durable reduction in pulmonary arterial blood flow with no pulmonary artery distortion. Early mortality was low for EPAB alone. Endoluminal pulmonary artery banding alone is preferred when controlled pulmonary blood flow and cardiopulmonary bypass are required to address intracardiac abnormalities. The role of EPAB with APW needs to be defined.
Locker
Chaim
C
Division of Cardiovascular Surgery, Mayo Clinic, Rochester, Minnesota 55905, USA. lekerlocker.chaim@mayo.edu
Dearani
Joseph A
JA
O'Leary
Patrick W
PW
Puga
Francisco J
FJ
D001028:Aortopulmonary Septal Defect / Q000601:surgery; D002315:Cardiopulmonary Bypass; D002648:Child; D002675:Child, Preschool; D005260:Female; D006330:Heart Defects, Congenital / Q000453:epidemiology / Q000601:surgery*; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D011651:Pulmonary Artery / Q000601:surgery*; D013577:Syndrome; D016896:Treatment Outcome