Modified pulmonary artery banding: A novel strategy for balancing pulmonary blood flow with transposed great arteriesCentral MessagePerspective
Objective: To study the outcomes of a novel modified pulmonary artery banding (mPAB) technique used for staged repair of a subset of patients with complex transposition physiology. Methods: A total of 13 patients who underwent mPAB during their staged repair (biventricular repair [BVR], n = 6) or pa...
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Elsevier
2021-10-01
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| Series: | JTCVS Techniques |
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| Online Access: | http://www.sciencedirect.com/science/article/pii/S2666250721003886 |
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| author | Gananjay G. Salve, MS, MCh Andrew D. Cole, BAppSci (Hon) Ian A. Nicholson, FRACS David S. Winlaw, MD, FRACS Richard B. Chard, FRACS Yishay Orr, PhD, FRACS |
| author_facet | Gananjay G. Salve, MS, MCh Andrew D. Cole, BAppSci (Hon) Ian A. Nicholson, FRACS David S. Winlaw, MD, FRACS Richard B. Chard, FRACS Yishay Orr, PhD, FRACS |
| author_sort | Gananjay G. Salve, MS, MCh |
| collection | DOAJ |
| description | Objective: To study the outcomes of a novel modified pulmonary artery banding (mPAB) technique used for staged repair of a subset of patients with complex transposition physiology. Methods: A total of 13 patients who underwent mPAB during their staged repair (biventricular repair [BVR], n = 6) or palliation (1-1/2 repair, n = 1; univentricular repair [UVR], n = 6) from 2004 to 2020 were studied retrospectively. A restrictive interposition graft was used to reconstruct the main PA between the pulmonary root and the distal pulmonary confluence, functioning as a mPAB. Twelve of the 13 patients (92.3%) underwent a concurrent arterial switch operation (ASO), of which 6 were palliative ASOs for 1-1/2 repair (n = 1) or UVR (n = 5). Patient weight and cardiac anatomy determined the size of interposition graft. Results: The disease spectrum included dextro transposition of the great arteries (d-TGA) with multiple ventricular septal defects (VSDs) (n = 4), Taussig–Bing anomaly (n = 3), d-TGA with VSD and hypoplastic right ventricle (RV) (n = 3), double-inlet left ventricle with l-TGA (n = 2), and congenitally corrected TGA with double-outlet RV (n = 1). The Lecompte procedure was performed in 10 patients. Predischarge echocardiography revealed a band gradient of 61 mm Hg (interquartile range [IQR], 40-90 mm Hg) for BVR/1-1/2 ventricular repair (n = 7) and 49 mm Hg (IQR, 37-61 mm Hg) for UVR (n = 6). Survival was 100% at a median follow-up of 3.7 years (IQR, 2.6-4.0 years). Conclusions: The mPAB technique is effective and reproducible for staged BVR or UVR for patients with TGA. It effectively regulates pulmonary blood flow, may reduce neopulmonary root distortion, and eliminates complications associated with band migration in standard PAB. |
| format | Article |
| id | doaj-art-bd8e230bfd764e0693e49eba65c43308 |
| institution | Kabale University |
| issn | 2666-2507 |
| language | English |
| publishDate | 2021-10-01 |
| publisher | Elsevier |
| record_format | Article |
| series | JTCVS Techniques |
| spelling | doaj-art-bd8e230bfd764e0693e49eba65c433082025-08-20T04:01:57ZengElsevierJTCVS Techniques2666-25072021-10-01911112010.1016/j.xjtc.2021.05.021Modified pulmonary artery banding: A novel strategy for balancing pulmonary blood flow with transposed great arteriesCentral MessagePerspectiveGananjay G. Salve, MS, MCh0Andrew D. Cole, BAppSci (Hon)1Ian A. Nicholson, FRACS2David S. Winlaw, MD, FRACS3Richard B. Chard, FRACS4Yishay Orr, PhD, FRACS5Heart Centre for Children, The Children's Hospital at Westmead, Westmead, New South Wales, Australia; Address for reprints: Gananjay G. Salve, MS, MCh, Postgraduate Fellow, Paediatric Cardiothoracic Surgery, Heart Centre for Children, The Children's Hospital at Westmead, Cnr of Hawkesbury Rd & Hainsworth St, Locked Bag 4001, Westmead, NSW 2145, Australia.Heart Centre for Children, The Children's Hospital at Westmead, Westmead, New South Wales, AustraliaHeart Centre for Children, The Children's Hospital at Westmead, Westmead, New South Wales, Australia; Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, AustraliaCincinnati Children's Hospital Medical Center, Cincinnati, OhioHeart Centre for Children, The Children's Hospital at Westmead, Westmead, New South Wales, Australia; Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, AustraliaHeart Centre for Children, The Children's Hospital at Westmead, Westmead, New South Wales, Australia; Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, AustraliaObjective: To study the outcomes of a novel modified pulmonary artery banding (mPAB) technique used for staged repair of a subset of patients with complex transposition physiology. Methods: A total of 13 patients who underwent mPAB during their staged repair (biventricular repair [BVR], n = 6) or palliation (1-1/2 repair, n = 1; univentricular repair [UVR], n = 6) from 2004 to 2020 were studied retrospectively. A restrictive interposition graft was used to reconstruct the main PA between the pulmonary root and the distal pulmonary confluence, functioning as a mPAB. Twelve of the 13 patients (92.3%) underwent a concurrent arterial switch operation (ASO), of which 6 were palliative ASOs for 1-1/2 repair (n = 1) or UVR (n = 5). Patient weight and cardiac anatomy determined the size of interposition graft. Results: The disease spectrum included dextro transposition of the great arteries (d-TGA) with multiple ventricular septal defects (VSDs) (n = 4), Taussig–Bing anomaly (n = 3), d-TGA with VSD and hypoplastic right ventricle (RV) (n = 3), double-inlet left ventricle with l-TGA (n = 2), and congenitally corrected TGA with double-outlet RV (n = 1). The Lecompte procedure was performed in 10 patients. Predischarge echocardiography revealed a band gradient of 61 mm Hg (interquartile range [IQR], 40-90 mm Hg) for BVR/1-1/2 ventricular repair (n = 7) and 49 mm Hg (IQR, 37-61 mm Hg) for UVR (n = 6). Survival was 100% at a median follow-up of 3.7 years (IQR, 2.6-4.0 years). Conclusions: The mPAB technique is effective and reproducible for staged BVR or UVR for patients with TGA. It effectively regulates pulmonary blood flow, may reduce neopulmonary root distortion, and eliminates complications associated with band migration in standard PAB.http://www.sciencedirect.com/science/article/pii/S2666250721003886transposition of the great arteriesarterial switch operationmodified pulmonary artery bandingbiventricular repairuniventricular repair |
| spellingShingle | Gananjay G. Salve, MS, MCh Andrew D. Cole, BAppSci (Hon) Ian A. Nicholson, FRACS David S. Winlaw, MD, FRACS Richard B. Chard, FRACS Yishay Orr, PhD, FRACS Modified pulmonary artery banding: A novel strategy for balancing pulmonary blood flow with transposed great arteriesCentral MessagePerspective JTCVS Techniques transposition of the great arteries arterial switch operation modified pulmonary artery banding biventricular repair univentricular repair |
| title | Modified pulmonary artery banding: A novel strategy for balancing pulmonary blood flow with transposed great arteriesCentral MessagePerspective |
| title_full | Modified pulmonary artery banding: A novel strategy for balancing pulmonary blood flow with transposed great arteriesCentral MessagePerspective |
| title_fullStr | Modified pulmonary artery banding: A novel strategy for balancing pulmonary blood flow with transposed great arteriesCentral MessagePerspective |
| title_full_unstemmed | Modified pulmonary artery banding: A novel strategy for balancing pulmonary blood flow with transposed great arteriesCentral MessagePerspective |
| title_short | Modified pulmonary artery banding: A novel strategy for balancing pulmonary blood flow with transposed great arteriesCentral MessagePerspective |
| title_sort | modified pulmonary artery banding a novel strategy for balancing pulmonary blood flow with transposed great arteriescentral messageperspective |
| topic | transposition of the great arteries arterial switch operation modified pulmonary artery banding biventricular repair univentricular repair |
| url | http://www.sciencedirect.com/science/article/pii/S2666250721003886 |
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