Pulmonary Artery Banding in Patients with Left Ventricular Dilated Cardiomyopathy: Goal-Directed Postoperative Therapy for Safe Patient Guidance

Objectives: With the concept of surgical pulmonary artery banding (PAB) in left ventricular dilated cardiomyopathy (LV-DCM), a new therapeutic option with encouraging short- to medium-term outcomes has been established. Despite the relatively less invasive character of the surgical procedure, very dynamic adjustment processes take place in the direct postoperative period. For this very vulnerable phase, a goal-directed drug scheme was designed.

Methods: Patients undergoing PAB in DCM were postoperatively treated with e standardized medical protocol. Primary outcome was survival, and secondary outcomes were need for resuscitation, time to extubation, and length of stay on the ICU.

Results: Between 2006 und 2017, 32 patients (mean age at procedure 330 ± 373 days) were treated with PAB in DCM. In all patients, a goal-directed standard of care was applied.

Main target parameter was a heart rate range of 115 to 130 beats per minute (bpm). Further target parameters were renal and coronary perfusion pressure.

Applied drug therapy scheme comprised norepinephrine (0.1 ± 0.05 µg/kg/min), epinephrine (0.03 µg/kg/min), milrinone (1 µg/kg/min), metoprolol (0.1 mg/kg/h), clonidine (1 ± 1 µg/kg/h), and levosimendan (0.1 µg/kg/min). Furthermore, theophylline, reproterol, remifentanil, midazolam, and vecuronium were used according to clinical presentation.

The lethality during ICU stay was 0%. No resuscitation had to be performed. The average length of stay on ICU was 12 ± 7 days. Average time on ventilator was 2 ± 2 days.

Conclusion: The consistent adherence to the target parameters heart rate, renal, and coronary perfusion pressure allows a safe guidance in the early postoperative period after PAB in DCM. The paradigm of a physiologic tachycardia was contrasted with a multidrug-controlled economization of the heart rate.