Long-Term Outcome after Pulmonary Artery Debanding

Objectives: Pulmonary artery banding (PAB) is used as a palliation in patients with congenital heart defects. The aim of this retrospective study was to assess banding-related long-term morbidity.

Methods: A total of 168 patients underwent debanding following palliative cardiac surgery including external PAB between February 1990 and September 2008 in a single center. Debanding was performed by simple excision of the band in 79 (47%), excision of pulmonary artery stenosis and end-to-end anastomosis in 7 (4%), or pulmonary artery patch plasty in 71 (42%) patients. Median interval between external PAB and debanding was 17 months (range: 0–120 months). Cardiac diagnoses in patients with biventricular morphology (n = 128; 76%) included ventricular septal defect (n = 58; 34%), balanced AVSD (n = 64; 38%), cc-TGA (n = 1; 1%), d-TGA (n = 4; 3%), and common arterial trunk (n = 1; 1%). Ninety-three patients (55%) showed extracardiac anomalies, 70 of them (42%) with chromosomal aberrations.

Results: PAB-related infundibular hypertrophy or pulmonary valve impairment was addressed during debanding by commissurotomy (n = 3; 2%), transanular right-ventricular-to-outflow-tract (RVOT) patch plasty (n = 2; 1%), or right-ventricle-to-pulmonary-artery conduit implantation (n = 1; 1%); further treatment included central aortopulmonary shunting (n = 2; 1%). Hospital mortality after debanding was 6.6% (n = 11). The median follow-up (four patients were lost [2.1%]) after debanding was 14 years (range: 0–26 years). PAB-related further surgery included pulmonary valve replacement (n = 4; 2%), RVOT (n = 4; 2%), and main pulmonary artery patch plasty (n = 2; 1%). Survival after 1, 5, 10, and 15 years in uni- and biventricular patients was 77.5 ± 6.6, 72.4 ± 7.1, 67.2 ± 7.5, and 64.4 ± 7.7% and 88.2 ± 2.9, 85.0 ± 3.2, 85.0 ± 3.2, and 85.0 ± 3.2%, respectively (p = 0.006). Freedom from banding-related complications 1, 5, 10, and 15 years after debanding in uni- and biventricular patients was 75.0 ± 4.4, 70.0 ± 4.6 57.5 ± 5.0, and 35.0 ± 4.8% and 73.4 ± 4.4, 70.3 ± 4.6, 59.4 ± 4.9, and 43.0 ± 5.0%, respectively (p = 0.054).

Conclusion: Survival after debanding is acceptable and seems to be mainly affected by the underlying pathology. However, although PAB is considered as an “easy procedure,” its related long-term morbidity must not be underestimated.