Mortality of pulmonary artery banding in the current era: recent mortality of PA banding

Takayama, Hiroo; Sekiguchi, Akihiko; Chikada, Masahide; Noma, Mio; Ishizawa, Atsushi; Takamoto, Shinichi

doi:10.1016/s0003-4975(02)03900-0

Cited by 47 publications

(45 citation statements)

References 18 publications

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“…The distal PA pressure between 30% and 50% of systemic pressure and the distal systolic PA ICR, intracardiac repair; PAB, pulmonary artery banding; BW, body weight; PA, pulmonary artery. pressure below 30 mm Hg have been used as proper hemodynamics parameters (LeBlanc et al 1987;Van Nooten et al 1989;Pinho et al 1997;Takayama et al 2002). An alternative determining condition is the reduction of the mitral valve flow velocity by 50-70% compared with the rate before PAB as measured by echocardiography (Miyamura et al 1994).…”

Section: Discussionmentioning

confidence: 99%

“…Trusler and Mustard (1972) advocated that an adequate circumference for PAB in infants with VSDs without mixed disorders was 20 mm + 1 mm for each kilogram of BW. This formula has been widely accepted by many institutions (Takayama et al 2002;Baslaim 2009). On the basis of their clinical findings, their group later stated that the band should be approximately 1 mm tighter in infants weighing 2 kg or less (Albus et al 1984).…”

Section: Discussionmentioning

confidence: 99%

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Pulmonary Artery Banding for Neonates and Early Infants with Low Body Weight

Nagashima

Okamura

Shikata

et al. 2011

Tohoku J. Exp. Med.

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Open heart surgery for infants with low body weight (BW) remains still a challenge. Pulmonary artery banding (PAB) is a useful surgical palliation for small neonates and early infants with excessive pulmonary blood flow who are unable to withstand a heart surgery. This study retrospectively reviewed neonates and infants who underwent PAB to assess the surgical results and the validity of our PAB. We selected 38 acyanotic infants and neonates and divided them into 2 groups: low BW (< 2.5 kg, n = 15, group L) and normal or high BW (≥ 2.5 kg, n = 23, group NH). The average BW at the time of PAB was 2.8 ± 1.1 kg (range, 1.2-5.8 kg), and the average age at the time of PAB was 41.8 ± 44.8 days (range, 2-151 days). Using a 3-mm-wide polyester tape, we tightened the main pulmonary artery to obtain the circumference of (19 mm + 1 mm for each kg of BW). There was no early death but one late death in each group. Postoperative BW continuously increased 1 month after PAB in both groups, although BW was significantly lower in group L than in group NH. Intracardiac repair (ICR) was accomplished in 31 patients (13 in group L and 18 in group NH) at average ages of 1.5 years, while the remaining 5 patients are awaiting ICR. In conclusion, PAB using our formula for the infants even weighing < 2.5 kg has low mortality and is effective as a bridge to ICR.Keywords: infant; low birth weight; neonate; palliative surgery; pulmonary artery banding Tohoku J. Exp. Med., 2011, 225 (4), 255-262. © 2011 Tohoku University Medical PressIn neonates and early infants with low body weight (BW), cardiopulmonary bypass surgery increases organ edema and dysfunction, leading to high mortality and morbidity (Oppido et al. 2004). Pulmonary artery banding (PAB) remains a useful surgical palliation for small neonates and early infants with excessive pulmonary blood flow who are unable or difficult to withstand an open heart surgery using cardiopulmonary bypass. PAB can relieve the symptoms of heart failure and respiratory distress and prevent future pulmonary vascular obstructive disease in these infants and intracardiac repair (ICR) can be delayed until they grow. Trusler and Mustard (1972) advocated that the adequate circumference of the PAB using a 4-mm-wide tape in infants without cyanosis was (20 mm + 1 mm for each kg of the infant BW). The Trusler's formula has been used as a standard for PAB in pediatric cardiac surgery field for a long period. However, the average birth BW in the Japan is lower than in the United States and European countries and per se decreased in the recent years. A wider tape for PAB may cause the distal PA stenosis in small neonates and infants. In addition, the average BW in our PAB series was much lower than that reported previously. Therefore, in our institution, we have routinely used a 3-mm-wide tape (1 mm narrower than Trusler's group) and our modified formula (19 mm + 1 mm for each kg of BW), 1 mm shorter circumference than Trusler's formula] had been applied to obtain the appropriate PAB circumference (Fig. 1). Accord...

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Pulmonary Artery Banding for Neonates and Early Infants with Low Body Weight

Nagashima

Okamura

Shikata

et al. 2011

Tohoku J. Exp. Med.

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“…Thus, small changes in vessel diameter have a large impact on the flow and pressure gradient through the banding, providing the procedure, although simple, a development with variable -but significantmorbidity and mortality [5][6][7]. Proposals for pre-established perimeters, such as the classic rule of Trusler [11], in which the authors preconized a perimeter of the pulmonary artery to be obtained with the banding of 20 mm or 24 mm, by adding 1 mm/kg of weight, if the heart disease is cyanotic or acyanotic, respectively, rarely correspond to reality, although such proposals can be used as a reference to "starting point" of the constriction.…”

Section: Discussionmentioning

confidence: 99%

“…Takayama et al [7] analyzed the mortality of the PAB in their series since 1966, decade by decade. They noted progressive reduction in mortality, stabilized in the last two decades around 13.5%.…”

Section: Discussionmentioning

confidence: 99%

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Bandagem da artéria pulmonar: uma cirurgia simples? Uma análise crítica em um centro terciário

Valente¹,

Mesquita²,

Mejía³

et al. 2009

Rev Bras Cir Cardiovasc

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Bandagem da artéria pulmonar: uma cirurgia simples? Uma análise crítica em um centro terciário Pulmonary artery banding: a simple procedure? A critical analysis at a tertiary center Abstract Objective: Although pulmonary artery banding (PAB) seems to be a technically simple procedure it presents several peculiarities and is related to a significant morbidity and mortality. The aim of this study is to analyze the experience of a tertiary hospital on the PAB by assessing and correlating many aspects related to the procedure.Methods: Between January 2000 and December 2008, 61 patients undergone PAB due to congenital heart disease with increased pulmonary blood flow at Messejana Heart Hospital were assessed as for mortality, complications, stay in mechanical ventilation and need for intensive care unit (ICU), use of vasoactive drugs, difficulties in the adjustment on the banding and reoperations. Some statistical analyzes were performed to compare the subgroups.Results: In 36.17% of the patients the intended pressoric adjustment was not achieved and in 6.5% it was necessary another surgery to readjust the banding. The mean time of mechanical ventilation was 14.1±49.6 days and ICU 14.16±10.92 days. In 82.6% of the patients vasoactives drugs were administrated for 10.3±12.79 days. Severe complications were noted in 49.15% of patients and cardiac insufficiency was the most common one with an incidence of 44%. The mortality rate was 8.2% and it was not influenced by weight or associated procedures with the PAB neither if univentricular or biventricular heart disease.Conclusion: The PAB can be performed with acceptable mortality rates compatible with the ones of the world literature. Nevertheless, the adjustment of the banding is difficult to be assessed during the surgery by making the This study was carried out at Dr.

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Banding the Pulmonary Artery

Hoffman

2009

The Natural and Unnatural History of Congenital Heart Disease

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Mortality of pulmonary artery banding in the current era: recent mortality of PA banding

Cited by 47 publications

References 18 publications

Pulmonary Artery Banding for Neonates and Early Infants with Low Body Weight

Pulmonary Artery Banding for Neonates and Early Infants with Low Body Weight

Bandagem da artéria pulmonar: uma cirurgia simples? Uma análise crítica em um centro terciário

Banding the Pulmonary Artery

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