Pulmonary artery banding

Abstract

Pulmonary artery banding is a palliative surgical procedure used to treat functionally univentricular hearts, multiple ventricular septal defects and complete atrioventricular septal defects. Pulmonary artery banding has recently gained in interest for left ventricular retraining and hypoplastic left heart malformations. The indication for pulmonary artery banding is limited by several factors: difficulty of determining optimal band tightness, influence of perioperative variables with mutual interference, age-related variability of the ventricular adaptive response, difficulty of securing sufficiently tight banding in older children, repeated surgical procedures needed to adjust the band perimeter, long periods under intensive respiratory and/or pharmacological support, and the frequent need for reconstruction of the pulmonary artery at intracardiac repair. The need for adjustable banding has now been met by the clinical availability of telemetrically controlled adjustable pulmonary artery banding (FloWatch™, EndoArt, Lausanne, Switzerland), which has been successfully tested in clinical practice after favourable evaluation in animal experiments. This new wireless, battery free, implantable device (FloWatch™), allows repeated progressive occlusion and reopening of the device by remote control, at the desired percentage occlusion, without the need for reoperation to adjust the band. The introduction of FloWatch™ has brought substantial changes in the management of patients with increased pulmonary artery blood flow and pressure, a reduction in the mortality and morbidity associated with conventional banding, and significant shortening of intensive care unit and hospital stay. New therapeutic strategies could well extend the applicability of this device in patients with congenital heart defects.