Bilateral pulmonary arterial banding results in an increased need for subsequent pulmonary artery interventions

Ryan R Davies, Wolfgang A. Radtke, Dore Klenk, Christian Pizarro

Research output: Contribution to journalArticle

33 Citations (Scopus)

Abstract

Objective Despite increasing use of bilateral branch pulmonary artery banding (bPAB), both as a temporary stabilizing treatment and as part of comprehensive hybrid management of hypoplastic left heart syndrome, little is known about the long-term outcomes of the pulmonary arteries (PAs) in banded patients. Patients and Methods We conducted a retrospective review of all patients with ductal-dependent systemic circulation (2001-2013) undergoing bPAB placement at a single institution (bPAB, n = 50); patients who underwent a stage I Norwood procedure (Norwood, n = 53) were used for comparison. The need for PA interventions (surgical arterioplasty, balloon angioplasty, and stent implantation) and PA growth were assessed. Results Bands were in place for a median of 76 days. PA growth and size were similar between groups, but bPAB patients required more interventions (1.4 ± 2.9 vs 0.5 ± 1.2, P =.01). In competing risks analysis, only 20% of bPAB patients were alive and free from intervention at 5 years after bPAB removal. Multivariable Cox proportional hazards regression of operative interventions within the bPAB group demonstrated the following risk factors: subsequent 2-ventricle repairs (hazard ratio [HR], 2.2; 95% confidence interval [CI], 0.7-6.7), smallest band diameter (HR per additional millimeter, 0.059; 95% CI, 0.004-0.849), and duration of band placement more than 90 days (HR, 3.5; 95% CI, 1.0-12.6). Hemodynamics and Fontan candidacy did not differ between groups. Conclusions Patients with bPAB require additional interventions at earlier time points than Norwood patients. Patients with smaller bands and longer duration of banding are at high risk. Despite stenoses requiring additional interventions, Fontan candidacy is maintained.

Original languageEnglish (US)
Pages (from-to)706-712
Number of pages7
JournalJournal of Thoracic and Cardiovascular Surgery
Volume147
Issue number2
DOIs
StatePublished - Feb 1 2014

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Pulmonary Artery
Lung
Confidence Intervals
Norwood Procedures
Hypoplastic Left Heart Syndrome
Balloon Angioplasty
Growth
Stents
Pathologic Constriction
Hemodynamics

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Surgery
  • Pulmonary and Respiratory Medicine

Cite this

Bilateral pulmonary arterial banding results in an increased need for subsequent pulmonary artery interventions. / Davies, Ryan R; Radtke, Wolfgang A.; Klenk, Dore; Pizarro, Christian.

In: Journal of Thoracic and Cardiovascular Surgery, Vol. 147, No. 2, 01.02.2014, p. 706-712.

Research output: Contribution to journalArticle

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abstract = "Objective Despite increasing use of bilateral branch pulmonary artery banding (bPAB), both as a temporary stabilizing treatment and as part of comprehensive hybrid management of hypoplastic left heart syndrome, little is known about the long-term outcomes of the pulmonary arteries (PAs) in banded patients. Patients and Methods We conducted a retrospective review of all patients with ductal-dependent systemic circulation (2001-2013) undergoing bPAB placement at a single institution (bPAB, n = 50); patients who underwent a stage I Norwood procedure (Norwood, n = 53) were used for comparison. The need for PA interventions (surgical arterioplasty, balloon angioplasty, and stent implantation) and PA growth were assessed. Results Bands were in place for a median of 76 days. PA growth and size were similar between groups, but bPAB patients required more interventions (1.4 ± 2.9 vs 0.5 ± 1.2, P =.01). In competing risks analysis, only 20{\%} of bPAB patients were alive and free from intervention at 5 years after bPAB removal. Multivariable Cox proportional hazards regression of operative interventions within the bPAB group demonstrated the following risk factors: subsequent 2-ventricle repairs (hazard ratio [HR], 2.2; 95{\%} confidence interval [CI], 0.7-6.7), smallest band diameter (HR per additional millimeter, 0.059; 95{\%} CI, 0.004-0.849), and duration of band placement more than 90 days (HR, 3.5; 95{\%} CI, 1.0-12.6). Hemodynamics and Fontan candidacy did not differ between groups. Conclusions Patients with bPAB require additional interventions at earlier time points than Norwood patients. Patients with smaller bands and longer duration of banding are at high risk. Despite stenoses requiring additional interventions, Fontan candidacy is maintained.",
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