Long-Term Outcome After Pulmonary Artery Banding in Children With Atrioventricular Septal Defects
Edward Buratto1, Brandon Khoo2, Xin Tao Ye2
1Department of Cardiac Surgery, The Royal Children's Hospital, Melbourne, Victoria, Australia; Department of Pediatrics, The University of Melbourne, Melbourne, Victoria, Australia; Murdoch Children's Research Institute, Melbourne, Victoria, Australia.
Insights
Pulmonary artery banding (PAB) in atrioventricular septal defect (AVSD) patients is safe for atrioventricular valve function. While most balanced AVSD patients achieve biventricular repair, reoperation is common; unbalanced AVSD patients show outcomes similar to the general population.
Area of Science:
- Pediatric Cardiology
- Congenital Heart Disease Surgery
Background:
- Atrioventricular septal defect (AVSD) is a congenital heart condition.
- Pulmonary artery banding (PAB) is a surgical procedure sometimes used in AVSD management.
- Long-term outcomes of PAB in AVSD patients remain underreported.
Purpose of the Study:
- To evaluate the long-term outcomes of pulmonary artery banding (PAB) in children with atrioventricular septal defect (AVSD).
- To assess the impact of PAB on atrioventricular valve (AVV) function and subsequent repair strategies.
Main Methods:
- Retrospective study of pediatric patients with AVSD who underwent PAB.
- Data collected from medical records and physician correspondence.
- Analysis of outcomes including biventricular repair, Fontan completion, survival, and AVV reoperation rates.
Main Results:
- 68 patients with complete AVSD underwent PAB.
- Balanced AVSD (bAVSD) patients (58.8%) primarily underwent PAB for future biventricular repair.
- Unbalanced AVSD (uAVSD) patients (41.2%) underwent PAB as part of univentricular palliation.
- PAB did not acutely worsen AVV regurgitation.
- At 20 years, bAVSD patients showed 73.4% survival and 60.0% freedom from AVV reoperation; 83.8% achieved biventricular repair.
- At 20 years, uAVSD patients showed 60.9% survival and 78.6% freedom from AVV reoperation; 61.9% achieved Fontan completion by 10 years.
Conclusions:
- PAB is a viable option for AVSD patients, not compromising AVV function.
- Most bAVSD patients can proceed to biventricular repair, though AVV reoperation rates are high.
- Outcomes for uAVSD patients undergoing PAB align with the general uAVSD population.
Background:
Patients with atrioventricular septal defect (AVSD) may require pulmonary artery banding (PAB), either as a part of a staged univentricular palliation or to allow delayed biventricular repair in patients presenting with early heart failure. The long-term outcomes of PAB in children with AVSD have not been previously reported.
Methods:
All children with AVSD who underwent PAB at a single institution were included in the study. Data were obtained from medical records and correspondence with general practitioners and cardiologists.
Results:
A total of 68 patients with complete AVSD underwent PAB, of whom 58.8% of patients (40 of 68) had balanced AVSD (bAVSD) and underwent PAB with intent to subsequently perform biventricular repair. The remaining 41.2% of patients (28 of 68) had unbalanced AVSD (uAVSD) and underwent PAB as part of staged univentricular repair. PAB was not associated with a short-term increase in atrioventricular valve (AVV) regurgitation (p = 0.24). In patients with bAVSD, 83.8% (95% confidence interval [CI]: 67.4% to 92.4%) achieved biventricular repair. Survival was 73.4% (95% CI: 54.3% to 85.5%) and freedom from left AVV operation was 60.0% (95% CI: 36.1% to 77.4%) at 20 years of follow-up. In patients with uAVSD, 61.9% (95% CI: 40.5% to 77.5%) had achieved Fontan completion at 10 years of follow-up. Survival was 60.9% (95% CI: 36.2% to 78.5%) and freedom from AVV operation was 78.6% (95% CI: 55.5% to 90.6%) at 20 years.
Conclusions:
PAB can be used in patients with AVSD without compromising AVV function. Most patients with bAVSD progress to biventricular repair, albeit with a high rate of AVV reoperation. Patients with uAVSD who undergo PAB have similar outcomes to the overall uAVSD population.
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