Pulmonary artery banding. Experience with 69 patients

Between 1976 and 1985, 69 patients underwent pulmonary artery banding (PAB) at an average age of 2.2 months (mo) (range 2 days-18 mo) weighing 3.8 kg (2.1-10.7 kg), as part of their initial surgical therapy for massive left to right shunting. Only 10 patients (early in this series) had isolated ventricular septal defect (VSD). Seventeen patients did not survive PAB (25%), including 4 of 5 patients with Taussig-Bing heart (TBH) and only 4 of the 40 patients with VSD [either isolated or associated with coarctation or transposition (TGA)]. Forty-four patients underwent debanding (deB) and secondary cardiac repair at an average age of 22 mo (6-96) and weight of 9.4 kg (4.9-22.0): 9 patients died early and 1 late. Mean pulmonary artery pressure was 49 Torr (27-80) before banding and 24 before deB (6-65). PA stenosis from the band imposed further surgery in all but 15 patients. Thirty-four survivors to secondary repair were followed for an average 46 mo (1-120). Thirty were in NYHA classes I and II. Only 43% of patients with PAB had good medium term results. The presence of the band imposes close, complete follow-up. PAB is no longer recommended for isolated single VSD. It can still be beneficial in multiple, complicated, or medically compromised VSD as well as in very small neonates with atrioventricular septal defect and truncus arteriosus, and subsets of double outlet right ventricle and tricuspid atresia with high pulmonary flow not amenable to early complete repair. PAB in functional single ventricle allows safer delayed definitive repair. TBH and TGA+VSD are now repaired primarily (arterial switch).