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Pulmonary artery banding revisited
I L Kron1, S P Nolan, T L Flanagan
1Department of Surgery, University of Virginia Health Sciences Center, Charlottesville 22908.
Insights
Pulmonary artery (PA) banding is effective for infants with congenital heart disease, especially single ventricle defects. This procedure shows a 12% 30-day mortality for single ventricle patients, with 92% 10-year survival.
Area of Science:
- Pediatric Cardiology
- Congenital Heart Disease Surgery
- Cardiovascular Interventions
Background:
- Pulmonary artery (PA) banding, introduced in 1952, is a palliative surgical procedure.
- It aims to reduce excessive pulmonary blood flow in complex congenital heart conditions.
- The study reviews outcomes of PA banding performed between 1955 and 1988.
Purpose of the Study:
- To evaluate the long-term outcomes and mortality rates of PA banding in pediatric patients.
- To assess the efficacy of PA banding across different preoperative diagnoses.
- To determine the current role of PA banding in managing congenital heart disease.
Main Methods:
- Retrospective review of 170 children undergoing PA banding at the University of Virginia Medical Center.
- Analysis of patient outcomes stratified by preoperative diagnoses.
- Calculation of 30-day and late mortality rates, and actuarial survival.
Main Results:
- Overall late mortality was approximately 10% (1% per year).
- Children with single ventricle defects had a significantly lower 30-day mortality (12%) compared to other diagnoses (30%, p<0.05).
- Actuarial survival at 10 years for single ventricle patients was 92%.
Conclusions:
- PA banding remains a valuable intervention for specific congenital heart diseases, particularly in infants with single ventricle physiology.
- The indication for PA banding in single ventricle infants aligns with historical recommendations.
- Improved surgical techniques and early correction have reduced the overall use of PA banding but not eliminated its critical role.
Abstract:
Pulmonary artery (PA) banding to reduce pulmonary blood flow was described by Muller and Dammann in 1952. This review describes the outcome of 170 children who had PA banding at the University of Virginia Medical Center between 1955 and 1988. One hundred and one of the patients were banded between 1958 and 1970; fewer bands were placed in later years because early total correction was feasible for certain conditions. When analyzed by preoperative diagnoses, the data reveal that children with a single ventricle undergoing banding had a significantly lower 30-day mortality rate of 12% compared to other preoperative diagnoses, including atrioventricular canal, truncus arteriosus, and ventricular septal defect (VSD) at 30% (p less than 0.05). The late overall mortality for all patients was approximately 10%, an attrition rate of 1% per year. PA banding still has a role in management of patients with congenital heart disease, particularly for infants with a single ventricle. Actuarial survival at 10 years for patients with this condition is 92%. Interestingly, this indication for pulmonary banding is the same one cited in the original report.