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Left Ventricular Re-training: Feasibility and Effectiveness-What Are the Limits?

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Pulmonary artery banding can retrain the morphologic left ventricle (mLV) but responses are complex. Early banding in infancy yields the best long-term mLV function and repair suitability.

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Area of Science:

  • Cardiovascular Surgery
  • Pediatric Cardiology
  • Congenital Heart Disease

Background:

  • Pulmonary artery banding is used to retrain the morphologic left ventricle (mLV) by applying afterload.
  • The physiological, molecular, and structural responses to banding are not fully understood.
  • Re-training occurs in diverse morphological settings and age groups, complicating outcomes.

Purpose of the Study:

  • To review evidence on mLV re-training in various clinical scenarios.
  • To emphasize the impact of age at banding on re-training effectiveness and suitability for repair.
  • To explore optimal methods for assessing mLV training, particularly in congenitally corrected transposition.

Main Methods:

  • Review of existing evidence on pulmonary artery banding for mLV re-training.
  • Focus on age-specific outcomes and assessment strategies.
  • Analysis of combined pressure and volume loading techniques.

Main Results:

  • Age at banding significantly impacts re-training success and long-term mLV function.
  • Optimal results are observed when banding occurs in infancy.
  • Concerns exist for interventions performed after 2 years of age.

Conclusions:

  • Early infant banding is crucial for successful mLV re-training and favorable long-term outcomes.
  • Age is a fundamental factor influencing the ability to re-train the mLV.
  • Further research is needed for sophisticated assessment of training adequacy.