Utility of late pulmonary artery banding in single-ventricle physiology: A mid-term follow-up

Abstract

Background: The standard first stage palliation for univentricular heart with unrestricted pulmonary blood flow (PBF) is surgical pulmonary artery (PA) banding for which the ideal age is within the first 8 weeks of life. This study aimed to look for the utility of PA band done beyond 3 months of age for patients presenting beyond the stipulated period.

Materials and methods: This is a retrospective analysis of the outcome of twenty patients with single ventricle (SV) physiology with unrestricted PBF who presented late and were selected on the basis of clinical, radiological, and echocardiographic parameters for PA banding.

Results: The median age of the patients was 5.5 months (3.5-96 months), and the median body weight was 4.7 kg (3.2-22.0 kg). The patients were divided into three groups as follows: ten patients between 3 and 6 months of age (Group A), seven patients between 6 months to 1 year of age (Group B), and three patients > 1 year of age with additional features of pulmonary venous hypertension (Group C). The mean reduction of PA pressures following PA band was 60.9%, 48.8%, and 58.3% and the mean fall in oxygen saturation was 10.4%, 8.0%, and 6.6% in the three groups, respectively. The postoperative mortality rate was 10%. The mean follow up duration was 13.5 months (7-23 months). There was a statistically significant improvement in weight for age Z scores following PA band (P = 0.0001). On follow up cardiac catheterization, the mean PA pressures were 16.6 (±3.6), 22.7 (±5.7), and 33.3 (±12.4) mmHg, respectively, in the three groups, and the mean pulmonary vascular resistance index was 1.86 (±0.5), 2.45 (±0.7), and 3.5 (±1.6) WU.m2, respectively. Subsequently, seven patients in Group A, three patients in Group B, and one patient from Group C underwent successful bidirectional Glenn (BDG) surgery.

Conclusions: Late PA band in selected patients with SV physiology can have definite benefit in terms of correction of heart failure symptoms and subsequent conversion to BDG and can potentially change the natural history of disease both in terms of survival and quality of life.

Keywords: Late pulmonary artery band; pulmonary vascular disease; single ventricle; unrestrictive pulmonary blood flow.

Figure 1

Distribution of the study population with overall outcome

Figure 2

Significant improvement in WHO weight-for-age Z scores from baseline to 6-month follow-up or completion of second stage (bidirectional Glenn)

Figure 3

Correlation between age at the time of pulmonary artery banding and pre bidirectional Glenn mean pulmonary arterial pressures (a); pre bidirectional Glenn pulmonary vascular resistance index (b)

Figure 4

Medical follow-up versus late pulmonary artery band in single-ventricle patients with unrestrictive pulmonary blood flow (>3 months of age); dotted lines indicate possible future outcomes