Pulmonary artery banding for functionally single ventricles: impact of tighter banding in staged Fontan era.
BACKGROUND
In this study, we assessed our surgical strategy, tighter pulmonary artery banding (PAB) during the neonatal period, as an initial step followed by early application of bidirectional cavopulmonary shunts (BCPS) in infancy, to treat functionally single ventricles with unobstructed pulmonary blood flow.


METHODS
On the basis of our surgical strategy, 68 consecutive patients underwent PAB and were divided into two groups, group 1 (January 1990 to June 2003; n = 30) and group 2 (July 2003 to August 2008; n = 38). The median age at PAB was 45 days in group 1 and 9 days in group 2. The circumference of the bands was significantly shorter in group 2 than in group 1, corresponding to the patient's weight in kg plus 19.0 +/- 0.6 mm in group 1 or 17.0 +/- 0.3 mm in group 2 (p = 0.003).


RESULTS
Cardiac catheterization before the right heart bypass operation showed that the pulmonary artery index (group 1, 322 +/- 29; group 2, 283 +/- 27 mm(2)/m(2); p = 0.01), pulmonary resistance index (group 1, 2.4 +/- 0.2; group 2, 1.9 +/- 0.1 U x m(2); p = 0.03), and ventricular end-diastolic volume (group 1, 212 +/- 19%; group 2, 166 +/- 9%; p = 0.04) were significantly different between the two groups. The rates for achievement of right heart bypass at 12 months (group 1, 19%; group 2, 81%; p < 0.01) and survival at 3 years (group 1, 70%; group 2, 87%; p = 0.04) were significantly higher in group 2 than in group 1.


CONCLUSIONS
Our present strategy could prevent volume overload and improve the achievement and survival rates of right heart bypass operations.
Kajihara
Noriyoshi
N
Department of Cardiovascular Surgery, Kanagawa Children's Medical Center, Yokohama, Japan. n-c.kaji@f6.dion.ne.jp
Asou
Toshihide
T
Takeda
Yuko
Y
Kosaka
Yoshimichi
Y
Onakatomi
Yasuko
Y
Nagafuchi
Hiroyuki
H
Yasui
Seiyo
S
D001783:Blood Flow Velocity / Q000502:physiology; D002675:Child, Preschool; D005500:Follow-Up Studies; D018729:Fontan Procedure / Q000379:methods*; D006330:Heart Defects, Congenital / Q000503:physiopathology / Q000601:surgery*; D006352:Heart Ventricles / Q000002:abnormalities* / Q000503:physiopathology / Q000601:surgery; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D011651:Pulmonary Artery / Q000503:physiopathology / Q000601:surgery*; D012189:Retrospective Studies; D013997:Time Factors; D016896:Treatment Outcome