title: Pulmonary artery banding: still a valuable option in developing countries?
abstract: OBJECTIVE
  We examined whether the socio-economic circumstances of a developing country justify pulmonary artery banding (PAB) for the deferral of perceived high-risk patients requiring biventricular repair.
  
  
  METHODS
  A retrospective cohort analysis was done on 143 consecutive patients with ventricular anatomy suitable for a biventricular repair, who had a pulmonary artery band applied between 1 January 2002 and 31 December 2007 as they were considered too high a risk to undergo corrective surgery. The goal in all patients was to lower their risk of definitive surgery by improving their clinical condition. The minimum follow-up period was 2 years with the closing date for data collection being 31 January 2010. The mean weight and age at PAB was 5.34 ± 2.94 kg and 9.9 ± 17.3 months. The endpoints of the study were mortality, interval hospital readmission, growth pattern post-banding, whether or not definitive correction was achieved, and the current follow-up status of uncorrected patients.
  
  
  RESULTS
  The hospital mortality was 8% (n = 12), the inter-stage mortality 21% (n = 30), and the total mortality 29% (n = 42). Positive growth was not shown in 50% following the banding procedure. The mean number of inter-current hospital admissions was 1.5 ± 2 times per patient. At the termination of data collection, after a mean interval of 24.5 ± 14.3 months, debanding and full correction was achieved in 43% (n = 62). In addition to the 29% (n = 42) that were confirmed to be dead, an additional 28% (n = 39) were not corrected and of these almost half were regarded as lost to follow-up. Thus, of the entire cohort of patients, 57% (n = 81) have not achieved definitive correction at the termination of data collection.
  
  
  CONCLUSIONS
  A strategy of deferring biventricular repair by the application of a pulmonary artery band is ineffective under Third World conditions largely due to lack of patient compliance. This study shows that the overall mortality in the inter-stage period following PAB is high prior to definitive correction. Less than half of patients will eventually be repaired in a reasonable time frame and patient follow-up is unreliable. We conclude that consideration should be given to early definitive repair even in perceived high-risk cases.
authors: Christiaan Barnard Division of Cardiothoracic Surgery, Red Cross Children's Hospital, University of Cape Town, Cape Town, South Africa. andre.brooks@uct.ac.za
authors: Andre
authors: A
authors: Brooks
authors: Agneta
authors: A
authors: Geldenhuys
authors: Liesl
authors: L
authors: Zuhlke
authors: Paul
authors: P
authors: Human
authors: Peter
authors: P
authors: Zilla
mesh_terms: D017677:Age Distribution; D000367:Age Factors; D002648:Child; D002675:Child, Preschool; D003250:Constriction; D003906:Developing Countries; D005260:Female; D005500:Follow-Up Studies; D006343:Heart Septal Defects / Q000601:surgery*; D006344:Heart Septal Defects, Atrial / Q000601:surgery; D006345:Heart Septal Defects, Ventricular / Q000601:surgery; D006801:Humans; D007223:Infant; D008297:Male; D010166:Palliative Care / Q000379:methods; D010352:Patient Dropouts / Q000706:statistics & numerical data; D011651:Pulmonary Artery / Q000601:surgery*; D012189:Retrospective Studies; D016896:Treatment Outcome