Modified pulmonary artery banding: A novel strategy for balancing pulmonary blood flow with transposed great arteries

Autor: David S. Winlaw, Gananjay G. Salve, Yishay Orr, Andrew D. Cole, Ian A. Nicholson, Richard B. Chard
Rok vydání: 2021
Předmět:
Pulmonary and Respiratory Medicine
d-TGA
dextro transposition of the great arteries
congenital
hereditary
and neonatal diseases and abnormalities
medicine.medical_specialty
univentricular repair
PTFE
polytetrafluoroethylene
Cx
circumflex artery
levo-Transposition of the great arteries
dextro-Transposition of the great arteries
Pulmonary artery banding
mPAB
modified pulmonary artery banding
PAB
pulmonary artery banding
biventricular repair
l-TGA
levo transposition of the great arteries
medicine.artery
Internal medicine
LPA
left pulmonary artery
RV
right ventricle/ventricular
Medicine
IQR
interquartile range
Congenital: Transposition of the Great Arteries
transposition of the great arteries
VSD
ventricular septal defect
ASO
arterial switch operation
business.industry
BDGS
bidirectional Glenn shunt
Left pulmonary artery
medicine.disease
Right pulmonary artery
RPA
right pulmonary artery
PA
pulmonary artery
modified pulmonary artery banding
medicine.anatomical_structure
UVR
univentricular repair
Ventricle
Great arteries
Pulmonary artery
BVR
biventricular repair
Cardiology
Surgery
business
arterial switch operation
Zdroj: JTCVS Techniques
ISSN: 2666-2507
DOI: 10.1016/j.xjtc.2021.05.021
Popis: 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.
Graphical abstract
Databáze: OpenAIRE
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