Related Experiment Video
Updated: May 31, 2026
Rat Model of Right-Sided Cardiac Remodeling and Arrhythmia Using Pulmonary Artery Banding
Published on: August 30, 2024
Pulmonary artery banding: still a valuable option in developing countries?
Andre Brooks1, Agneta Geldenhuys, Liesl Zuhlke
1Christiaan Barnard Division of Cardiothoracic Surgery, Red Cross Children's Hospital, University of Cape Town, Cape Town, South Africa. andre.brooks@uct.ac.za
Insights
Pulmonary artery banding (PAB) to defer high-risk biventricular repair in developing countries is ineffective due to poor compliance and high mortality. Early definitive repair is recommended even for high-risk patients.
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.
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.
Conclusion:
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.
