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Pulmonary artery banding: results and current indications in pediatric cardiac surgery
J G LeBlanc1, P G Ashmore, E Pineda
1Department of Cardiovascular and Thoracic Surgery, Children's Hospital, Vancouver, BC, Canada.
Insights
Pulmonary artery banding improved survival rates for infants and children with complex heart defects, especially in later years. This procedure is clinically effective for small patients with serious congenital anomalies.
Area of Science:
- Pediatric Cardiology
- Congenital Heart Disease Surgery
- Cardiovascular Surgery
Background:
- Pulmonary artery banding (PAB) is a palliative surgical procedure used in infants and children with complex congenital heart defects.
- Outcomes of PAB can vary significantly based on the type of cardiac anomaly and patient factors.
Purpose of the Study:
- To review the outcomes of pulmonary artery banding in a large cohort of pediatric patients.
- To identify factors influencing survival and clinical condition following PAB.
- To assess the impact of diagnostic groups and time periods on PAB outcomes.
Main Methods:
- Retrospective review of 144 patients who underwent pulmonary artery banding between 1971 and 1984.
- Patients were categorized into three diagnostic groups based on intracardiac mixing.
- Survival rates were analyzed across different diagnostic groups, time periods, and pre-operative weight.
Main Results:
- Overall survival was influenced by diagnostic group, with higher survival in defects without mixing disorders (88.8%) compared to those with mixing disorders or miscellaneous defects (64.9%).
- A significant improvement in survival was observed over time, increasing from 64.3% in 1971-1974 to 92.5% in 1980-1984.
- While low weight (<4 kg) was associated with lower survival in the early period, this difference diminished in the later period, indicating improved outcomes for smaller infants.
Conclusions:
- Pulmonary artery banding demonstrates satisfactory clinical outcomes in infants and children with complex congenital heart anomalies.
- Improvements in surgical management and patient care over time have significantly enhanced survival rates.
- The procedure remains a valuable palliative option for complex pediatric cardiac conditions.
Abstract:
The results of pulmonary artery banding in 144 patients seen from 1971 to 1984 were reviewed. Age ranged from 1 week to 4 years (median, 8 weeks) and weight, from 1.1 to 16 kg (median, 4 kg). The patients were divided into three major groups: Group 1, defects without mixing disorders (ventricular septal defect, double-outlet right ventricle [DORV], atrioventricular septal defect); Group 2, defects with mixing disorders (transposition of the great arteries, DORV, single ventricle, tricuspid atresia); and Group 3, miscellaneous (mitral atresia, left ventricular hypoplasia, truncus complex). The diagnostic group influenced survival (p = 0.0035). In Group 1, 88.8% survived, but only 64.9% survived in Groups 2 and 3 combined. The presence of patent ductus arteriosus or coarctation of the aorta had no effect on survival (p = 0.61 and p = 0.7, respectively). The clinical condition at thirty days after pulmonary artery banding was good in 35.1% and fair in 46.9% of the patients. When the data were divided into the three periods 1971 through 1974, 1975 through 1979, and 1980 through 1984, which included 28, 49, and 67 patients, respectively, a significant improvement in survival was observed from the early (64.3%) to the late period (92.5%) (p = 0.0009). Patients weighing less than 4 kg had a significantly lower survival in the period 1971 through 1974 (37.5% versus 91.67%). No significant difference in survival was detected in the late period, 1980 to 1984 (90% versus 94.6%), between patients weighing less than and those weighing more than 4 kg. Pulmonary artery banding is clinically satisfactory in small infants and children with complex anomalies.