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Complete atrioventricular septal defect: outcome of pulmonary artery banding improved by adjustable device
Ramana Rao V Dhannapuneni1, Gordon Gladman, Stephen Kerr
1Cardiac Unit, Alder Hey Children NHS Foundation Trust, Liverpool, United Kingdom.
Objective:
We sought to evaluate pulmonary artery banding in infants with complete atrioventricular septal defects.
Methods:
From 2000 to 2009, 20 infants with complete atrioventricular septal defects underwent pulmonary artery banding because of unsuitable anatomy (unbalanced ventricles, associated lesions, or both) or clinical condition (infection, chronic lung disease, or noncardiac malformation). Patients were divided into 2 groups: the conventional PAB group (n = 13 [65%]; mean age, 74 ± 56 days [range, 6-187 days]; mean weight, 3.3 ± 1.1 kg [range, 2.1-5.8 kg]) and the FloWatch-PAB group (n = 7 [35%]; mean age, 111 ± 40 days [range, 81-187 days]; mean weight, 4.3 ± 1.2 kg [range, 3.2-6.1 kg]). There was no statistical difference in age or weight. Preoperative mechanical ventilation was required in 3 (23%) of 13 infants in the conventional PAB group and 5 (71%) of 7 infants in the FloWatch-PAB group (P < .05).
Results:
Ten (77%) of 13 infants in the conventional PAB group died versus 0 (0%) of 7 infants in the FloWatch-PAB group (P < .001). Sternal closure was delayed in 6 (46%) of 13 infants in the conventional PAB group and 0 (0%) of 7 infants in the FloWatch-PAB group (P < .05). The mean duration of mechanical ventilation, intensive care unit stay, and hospital stay was significantly longer (P < .05) in the conventional PAB group than in the FloWatch-PAB group (21 ± 17 days [range, 4-61 days] vs 3 ± 2 days [range, 1-8 days], 22 ± 18 days [range, 5-61 days] vs 7 ± 6 days [range, 2-21 days], and 54 ± 12 days [range, 40-71 days] vs 29 ± 25 days [range, 9-81 days], respectively). Left atrioventricular valve regurgitation increased (mild to moderate) in 2 infants in the conventional PAB group and decreased (severe to moderate) in 2 infants in the FloWatch-PAB group. Six of 10 survivors (1 in the conventional PAB group and 5 in the FloWatch-PAB group) underwent pulmonary artery debanding and repair after a median interval of 125 days (range, 34-871 days); 4 of 10 are awaiting repair.
Conclusions:
In selected patients with complete atrioventricular septal defects, pulmonary artery banding followed by late repair is a viable alternative strategy. In our study the FloWatch-PAB device resulted in improved survival and made later repair possible in a better clinical state.
