title: Bilateral pulmonary arterial banding results in an increased need for subsequent pulmonary artery interventions.
abstract: OBJECTIVE
  Despite increasing use of bilateral branch pulmonary artery banding (bPAB), both as a temporary stabilizing treatment and as part of comprehensive hybrid management of hypoplastic left heart syndrome, little is known about the long-term outcomes of the pulmonary arteries (PAs) in banded patients.
  
  
  METHODS
  We conducted a retrospective review of all patients with ductal-dependent systemic circulation (2001-2013) undergoing bPAB placement at a single institution (bPAB, n = 50); patients who underwent a stage I Norwood procedure (Norwood, n = 53) were used for comparison. The need for PA interventions (surgical arterioplasty, balloon angioplasty, and stent implantation) and PA growth were assessed.
  
  
  RESULTS
  Bands were in place for a median of 76 days. PA growth and size were similar between groups, but bPAB patients required more interventions (1.4 ± 2.9 vs 0.5 ± 1.2, P = .01). In competing risks analysis, only 20% of bPAB patients were alive and free from intervention at 5 years after bPAB removal. Multivariable Cox proportional hazards regression of operative interventions within the bPAB group demonstrated the following risk factors: subsequent 2-ventricle repairs (hazard ratio [HR], 2.2; 95% confidence interval [CI], 0.7-6.7), smallest band diameter (HR per additional millimeter, 0.059; 95% CI, 0.004-0.849), and duration of band placement more than 90 days (HR, 3.5; 95% CI, 1.0-12.6). Hemodynamics and Fontan candidacy did not differ between groups.
  
  
  CONCLUSIONS
  Patients with bPAB require additional interventions at earlier time points than Norwood patients. Patients with smaller bands and longer duration of banding are at high risk. Despite stenoses requiring additional interventions, Fontan candidacy is maintained.
authors.affiliation: Nemours Cardiac Center, Nemours/A.I. duPont Hospital for Children, Wilmington, Del; Thomas Jefferson University, Philadelphia, Pa. Electronic address: rdavies@nemours.org.
authors.forename: Ryan R
authors.initials: RR
authors.lastname: Davies
authors.affiliation: Nemours Cardiac Center, Nemours/A.I. duPont Hospital for Children, Wilmington, Del; Thomas Jefferson University, Philadelphia, Pa.
authors.forename: Wolfgang A
authors.initials: WA
authors.lastname: Radtke
authors.affiliation: Nemours Cardiac Center, Nemours/A.I. duPont Hospital for Children, Wilmington, Del.
authors.forename: Dore
authors.initials: D
authors.lastname: Klenk
authors.affiliation: Nemours Cardiac Center, Nemours/A.I. duPont Hospital for Children, Wilmington, Del; Thomas Jefferson University, Philadelphia, Pa.
authors.forename: Christian
authors.initials: C
authors.lastname: Pizarro
mesh_terms: D000800:Angioplasty, Balloon / Q000295:instrumentation; D001157:Arterial Occlusive Diseases / Q000175:diagnosis / Q000503:physiopathology / Q000628:therapy*; D006348:Cardiac Surgical Procedures / Q000009:adverse effects; D016009:Chi-Square Distribution; D003251:Constriction, Pathologic; D005260:Female; D018729:Fontan Procedure; D006439:Hemodynamics; D006801:Humans; D018636:Hypoplastic Left Heart Syndrome / Q000175:diagnosis / Q000503:physiopathology / Q000601:surgery*; D007231:Infant, Newborn; D053208:Kaplan-Meier Estimate; D008297:Male; D015999:Multivariate Analysis; D058327:Norwood Procedures; D016016:Proportional Hazards Models; D011651:Pulmonary Artery / Q000254:growth & development / Q000503:physiopathology / Q000601:surgery*; D011652:Pulmonary Circulation; D012086:Reoperation; D012189:Retrospective Studies; D012307:Risk Factors; D015607:Stents; D013997:Time Factors; D016896:Treatment Outcome
keywords: 20; 26.6; 28.1; 28.2; BDG; CI; HR; IQR; OR; PA; bPAB; bidirectional Glenn; branch pulmonary arterial banding; confidence interval; hazard ratio; intraquartile range; odds ratio; pulmonary artery