Objective: We examined whether the socio-economic circumstances of a developing country justify pulmonary artery banding (PAB) for the deferral of perceived high-risk patients requiring biventricular repair. Methods: A retrospective cohort analysis was done on 143 consecutive patients with ventricular anatomy suitable for a biventricular repair, who had a pulmonary artery band applied between 1 January 2002 and 31 December 2007 as they were considered too high a risk to undergo corrective surgery. The goal in all patients was to lower their risk of definitive surgery by improving their clinical condition. The minimum follow-up period was 2 years with the closing date for data collection being 31 January 2010. The mean weight and age at PAB was 5.34 +/- 2.94 kg and 9.9 +/- 17.3 months. The endpointsof the study were mortality, interval hospital readmission, growth pattern post-banding, whether or not definitive correction was achieved, and the current follow-up status of uncorrected patients. Results: The hospital mortality was 8% (n = 12), the inter-stage mortality 21% (n = 30), and the total mortality 29% (n = 42). Positive growth was not shown in 50% following the banding procedure. The mean number of inter-current hospital admissions was 1.5 +/- 2 times per patient. At the termination of data collection, after a mean interval of 24.5 +/- 14.3 months, debanding and full correction was achieved in 43% (n = 62). In addition to the 29% (n = 42) that were confirmed to be dead, an additional 28% (n = 39) were not corrected and of these almost half were regarded as lost to follow-up. Thus, of the entire cohort of patients, 57% (n = 81) have not achieved definitive correction at the termination of data collection. Conclusion: A strategy of deferring biventricular repair by the application of a pulmonary artery band is ineffective under Third World conditions largely due to lack of patient compliance. This study shows that the overall mortality in the inter-stage period following PAB is high prior to definitive correction. Less than half of patients will eventually be repaired in a reasonable time frame and patient follow-up is unreliable. We conclude that consideration should be given to early definitive repair even in perceived high-risk cases. © The Author 2011. Published by Oxford University Press on behalf of the European Association for Cardio-Thoracic Surgery. All rights reserved.
CITATION STYLE
A., B., A., G., L., Z., P., H., & P., Z. (2012). Pulmonary artery banding: Still a valuable option in developing countries? European Journal of Cardio-Thoracic Surgery. A. Brooks, Chris Barnard Division of Cardiothoracic Surgery, Cape Heart Centre, University of Cape Town, Faculty of Health Sciences, Christiaan Barnard Building, 3rd Floor, Anzio Road, ZA-7925 Observatory, Cape Town, South Africa. E-mail: andre.brooks@uct: Oxford University Press (Great Clarendon Street, Oxford OX2 6DP, United Kingdom). Retrieved from http://ovidsp.ovid.com/ovidweb.cgi?T=JS&PAGE=reference&D=emed11&NEWS=N&AN=2012742517
Mendeley helps you to discover research relevant for your work.