Pulmonary artery banding: still a valuable option in developing countries?

Area of Science:

• Pediatric Cardiology
• Congenital Heart Disease Surgery
• Global Health

Background:

• Pulmonary artery banding (PAB) is used to defer high-risk biventricular repair in pediatric patients.
• Socio-economic factors in developing countries may impact the efficacy of staged surgical approaches.

Purpose of the Study:

• To evaluate the effectiveness of PAB in deferring biventricular repair for high-risk patients in a developing country.
• To assess outcomes including mortality, re-admission, growth, and definitive repair rates.

Main Methods:

• Retrospective cohort analysis of 143 consecutive patients undergoing PAB between 2002 and 2007.
• Patients were considered high-risk for immediate biventricular repair.
• Follow-up data collected until January 2010, with a minimum of 2 years post-PAB.

Main Results:

• Total mortality was 29% (42/143), with 21% inter-stage mortality.
• 50% of patients did not show positive growth post-banding.
• Only 43% (62/143) achieved definitive biventricular repair; 57% remained uncorrected.

Conclusions:

• PAB as a strategy to defer biventricular repair is largely ineffective in developing countries, primarily due to poor patient compliance.
• High inter-stage mortality and unreliable follow-up compromise the benefits of this approach.
• Early definitive biventricular repair should be considered even for high-risk pediatric patients.