title: Feasibility and related outcome of intraluminal pulmonary artery banding.
abstract: OBJECTIVE
  This retrospective study evaluated the feasibility and related outcome of intraluminal pulmonary artery banding (I-PAB).
  
  
  METHODS
  Thirty-two children underwent I-PAB between July 2006 and April 2014. The median age and weight were 60 days (range: 5 days to 4.2 years) and 3.7 kg (range: 2.6-13.0 kg), respectively. Cardiac diagnoses included single ventricle morphology (n = 11), complex ventricular septal defects (n = 11), balanced atrioventricular septal defects (n = 3), congenitally corrected transposition of the great arteries (n = 2) and aortic arch hypoplasia with ventricular septal defects (n = 5). On cardiopulmonary bypass (CPB), 2 I-PAB modifications with either 1 (n = 24) or 2 ('hour-glass-technique', n = 8) fenestrated pericardial patches were performed.
  
  
  RESULTS
  The median fenestration size was 5 mm (range: 4-6.5 mm). In 18 patients I-PAB was a solitary procedure; in 3 of them the decision was made intraoperatively. There was no hospital mortality. The median interval to debanding was 189 days (range: 112 days to 2.6 years). During this period, we observed a significant increase in the pressure gradient over I-PAB (P < 0.01), whereas arterial saturations remained stable. Four patients received balloon dilatation of I-PAB to prolong the palliation period. No patient experienced band occlusion, pulmonary hypertension related to I-PAB, coronary or pulmonary valve impairment. Debanding was performed in 27 patients and one of them required pulmonary patch arterioplasty due to I-PAB-associated pulmonary trunk distortion. Three patients are still awaiting further surgery. There were 2 late deaths prior to, and 3 after debanding, all not related to I-PAB.
  
  
  CONCLUSIONS
  I-PAB with an exactly defined internal orifice is feasible and effective. Although arterial saturations seem to remain stable, balloon dilatation of I-PAB can be performed safely and efficiently in order to prolong the palliation period. The rate of I-PAB-related complications is low, which might improve the long-term patient outcome. Therefore, despite requiring CPB, I-PAB is our institutional preference for children who require pulmonary artery banding.
authors.affiliation: Department of Pediatric Cardiac Surgery, Friedrich-Alexander-University Erlangen-Nuremberg, Erlangen, Germany stany.sandrio@uk-erlangen.de s.p.sandrio@googlemail.com.
authors.forename: Stany
authors.initials: S
authors.lastname: Sandrio
authors.affiliation: Department of Pediatric Cardiac Surgery, Friedrich-Alexander-University Erlangen-Nuremberg, Erlangen, Germany.
authors.forename: Ariawan
authors.initials: A
authors.lastname: Purbojo
authors.affiliation: Department of Pediatric Cardiology, University Heart Center Hamburg, Hamburg, Germany.
authors.forename: Florian
authors.initials: F
authors.lastname: Arndt
authors.affiliation: Department of Pediatric Cardiology, Friedrich-Alexander-University Erlangen-Nuremberg, Erlangen, Germany.
authors.forename: Okan
authors.initials: O
authors.lastname: Toka
authors.affiliation: Department of Pediatric Cardiology, Friedrich-Alexander-University Erlangen-Nuremberg, Erlangen, Germany.
authors.forename: Martin
authors.initials: M
authors.lastname: Glöckler
authors.affiliation: Department of Pediatric Cardiology, Friedrich-Alexander-University Erlangen-Nuremberg, Erlangen, Germany.
authors.forename: Sven
authors.initials: S
authors.lastname: Dittrich
authors.affiliation: Department of Pediatric Cardiac Surgery, Friedrich-Alexander-University Erlangen-Nuremberg, Erlangen, Germany.
authors.forename: Robert
authors.initials: R
authors.lastname: Cesnjevar
authors.affiliation: Department of Pediatric Cardiac Surgery, Friedrich-Alexander-University Erlangen-Nuremberg, Erlangen, Germany.
authors.forename: André
authors.initials: A
authors.lastname: Rüffer
mesh_terms: D001013:Aorta, Thoracic / Q000002:abnormalities / Q000601:surgery; D002675:Child, Preschool; D005240:Feasibility Studies; D005260:Female; D006343:Heart Septal Defects / Q000601:surgery*; D006352:Heart Ventricles / Q000002:abnormalities / Q000601:surgery*; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D011651:Pulmonary Artery / Q000601:surgery*; D012189:Retrospective Studies; D016896:Treatment Outcome; D014656:Vascular Surgical Procedures / Q000379:methods
keywords: Cardiopulmonary bypass; Paediatric; Pulmonary artery banding