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Rat Model of Right-Sided Cardiac Remodeling and Arrhythmia Using Pulmonary Artery Banding
Published on: August 30, 2024
Feasibility and related outcome of intraluminal pulmonary artery banding
Stany Sandrio1, Ariawan Purbojo2, Florian Arndt3
1Department of Pediatric Cardiac Surgery, Friedrich-Alexander-University Erlangen-Nuremberg, Erlangen, Germany stany.sandrio@uk-erlangen.de s.p.sandrio@googlemail.com.
Insights
Intraluminal pulmonary artery banding (I-PAB) is a feasible and effective procedure for pediatric heart conditions. This technique, even with cardiopulmonary bypass, shows a low complication rate and can improve long-term outcomes.
Area of Science:
- Pediatric Cardiology
- Cardiovascular Surgery
- Congenital Heart Disease
Background:
- Pulmonary artery banding is a palliative procedure for congenital heart defects.
- Intraluminal pulmonary artery banding (I-PAB) offers a modified approach.
- Evaluating the feasibility and outcomes of I-PAB is crucial for surgical decision-making.
Purpose of the Study:
- To assess the feasibility and outcomes of intraluminal pulmonary artery banding (I-PAB).
- To evaluate the safety and efficacy of I-PAB in pediatric patients.
- To determine the complication rate and long-term impact of I-PAB.
Main Methods:
- Retrospective analysis of 32 children undergoing I-PAB between July 2006 and April 2014.
- Diverse cardiac diagnoses including single ventricle morphology and complex VSDs.
- I-PAB performed using fenestrated pericardial patches (1 or 2) on cardiopulmonary bypass.
Main Results:
- No hospital mortality observed.
- Significant increase in pressure gradient over I-PAB with stable arterial saturations.
- Low rate of I-PAB-related complications; balloon dilatation used to prolong palliation.
Conclusions:
- I-PAB with a defined internal orifice is feasible and effective.
- Balloon dilatation of I-PAB is safe for prolonging palliation.
- Low complication rates suggest improved long-term patient outcomes with I-PAB.
Objectives:
This retrospective study evaluated the feasibility and related outcome of intraluminal pulmonary artery banding (I-PAB).
Methods:
Thirty-two children underwent I-PAB between July 2006 and April 2014. The median age and weight were 60 days (range: 5 days to 4.2 years) and 3.7 kg (range: 2.6-13.0 kg), respectively. Cardiac diagnoses included single ventricle morphology (n = 11), complex ventricular septal defects (n = 11), balanced atrioventricular septal defects (n = 3), congenitally corrected transposition of the great arteries (n = 2) and aortic arch hypoplasia with ventricular septal defects (n = 5). On cardiopulmonary bypass (CPB), 2 I-PAB modifications with either 1 (n = 24) or 2 ('hour-glass-technique', n = 8) fenestrated pericardial patches were performed.
Results:
The median fenestration size was 5 mm (range: 4-6.5 mm). In 18 patients I-PAB was a solitary procedure; in 3 of them the decision was made intraoperatively. There was no hospital mortality. The median interval to debanding was 189 days (range: 112 days to 2.6 years). During this period, we observed a significant increase in the pressure gradient over I-PAB (P < 0.01), whereas arterial saturations remained stable. Four patients received balloon dilatation of I-PAB to prolong the palliation period. No patient experienced band occlusion, pulmonary hypertension related to I-PAB, coronary or pulmonary valve impairment. Debanding was performed in 27 patients and one of them required pulmonary patch arterioplasty due to I-PAB-associated pulmonary trunk distortion. Three patients are still awaiting further surgery. There were 2 late deaths prior to, and 3 after debanding, all not related to I-PAB.
Conclusions:
I-PAB with an exactly defined internal orifice is feasible and effective. Although arterial saturations seem to remain stable, balloon dilatation of I-PAB can be performed safely and efficiently in order to prolong the palliation period. The rate of I-PAB-related complications is low, which might improve the long-term patient outcome. Therefore, despite requiring CPB, I-PAB is our institutional preference for children who require pulmonary artery banding.
