This Article Full Text Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Request Permissions Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Winlaw, D. S. Articles by Brawn, W. J. Search for Related Content PubMed PubMed Citation Articles by Winlaw, D. S. Articles by Brawn, W. J. Related Collections Other heart failure Pediatric and congenital heart disease, including cardiovascular surgery

(Circulation. 2005;111:405-411.)
© 2005 American Heart Association, Inc.

Cardiovascular Surgery

Intention-to-Treat Analysis of Pulmonary Artery Banding in Conditions With a Morphological Right Ventricle in the Systemic Circulation With a View to Anatomic Biventricular Repair

David S. Winlaw, MBBS, MD, FRACS; Simon P. McGuirk, BMedSci, MRCS; Christian Balmer, MD; Stephen M. Langley, MD, FRCS; Massimo Griselli, MD, MS, FRCS; Oliver Stümper, MD, PhD, MRCP; Joseph V. De Giovanni, MD, FRCP, FRCPCH; John G. Wright, MA, FRCP, FRCPCH; Sara Thorne, MD, MRCP; David J. Barron, MD, MRCP, FRCS; William J. Brawn, FRACS, FRCS

From the Diana, Princess of Wales Children’s Hospital, Birmingham Children’s Hospital NHS Trust, Birmingham, England.

Correspondence to David S. Winlaw, MBBS, MD, FRACS, Children’s Hospital at Westmead, Locked Bag 4001, Westmead NSW 2145, Australia. E-mail davidw{at}chw.edu.au

Received May 3, 2004; revision received September 22, 2004; accepted November 10, 2004.

Background— Some patients with a morphological right ventricle (mRV) in the systemic circulation require early intervention because of progressive systemic ventricular dysfunction or atrioventricular valve regurgitation. They may be eligible for anatomic repair (correction of atrioventricular and ventriculoarterial discordance) but require prior training of the morphological left ventricle (mLV).

Methods and Results— Forty-one patients with congenitally corrected transposition of the great arteries or a previous atrial switch procedure embarked on a protocol of pulmonary artery (PA) banding with a view to anatomic repair. All had an mRV in the systemic circulation and a subpulmonary mLV that was not conditioned by either volume or pressure load. Two patients were not banded, and 39 were followed up for a median of 4.3 years (range, 25 days to 12.6 years). Sixteen patients achieved anatomic repair, with 3 in the early stages of the training protocol. After 2 years, 12 patients were not suitable for anatomic repair and persisted with palliative banding; 8 were functionally improved; and 4 died, underwent transplantation, or required debanding. PA banding improved functional class but did not improve tricuspid regurgitation in the long term for patients not achieving anatomic repair. mLV function was a critical determinant of survival with a PA band as well as survival after anatomic repair. Patients >16 years were unlikely to achieve anatomic repair.

Conclusion— PA banding is a safe and effective method of training the mLV before anatomic repair. It is also an effective palliative procedure for those who do not attain this goal.

Key Words: heart defects, congenital • transposition of great vessels • surgery

This article has been cited by other articles:

				J. Horer, E. Karl, G. Theodoratou, C. Schreiber, J. Cleuziou, Z. Prodan, M. Vogt, and R. Lange Incidence and results of reoperations following the Senning operation: 27 years of follow-up in 314 patients at a single center Eur. J. Cardiothorac. Surg., June 1, 2008; 33(6): 1061 - 1067. [Abstract] [Full Text] [PDF]

				D. W. Quinn, S. P. McGuirk, C. Metha, P. Nightingale, J. V. de Giovanni, R. Dhillon, P. Miller, O. Stumper, J. G. Wright, D. J. Barron, et al. The morphologic left ventricle that requires training by means of pulmonary artery banding before the double-switch procedure for congenitally corrected transposition of the great arteries is at risk of late dysfunction. J. Thorac. Cardiovasc. Surg., May 1, 2008; 135(5): 1137 - 1144.e2. [Abstract] [Full Text] [PDF]

				A. F. Corno, E. J. Ladusans, M. Pozzi, and S. Kerr FloWatch versus conventional pulmonary artery banding. J. Thorac. Cardiovasc. Surg., December 1, 2007; 134(6): 1413 - 1420. [Abstract] [Full Text] [PDF]

				D. Schranz, A. Veldman, U. Bartram, I. Michel-Behnke, J. Bauer, and H. Akinturk Pulmonary artery banding for idiopathic dilative cardiomyopathy: A novel therapeutic strategy using an old surgical procedure J. Thorac. Cardiovasc. Surg., September 1, 2007; 134(3): 796 - 797. [Full Text] [PDF]

				V. Bautista-Hernandez, G. R. Marx, K. Gauvreau, J. E. Mayer Jr, F. Cecchin, and P. J. del Nido Determinants of Left Ventricular Dysfunction After Anatomic Repair of Congenitally Corrected Transposition of the Great Arteries Ann. Thorac. Surg., December 1, 2006; 82(6): 2059 - 2066. [Abstract] [Full Text] [PDF]

				Y. Boudjemline, E. Pineau, C. Bonnet, A. Mollet, S. Abadir, D. Bonnet, D. Sidi, and G. Agnoletti Off-label use of an adjustable gastric banding system for pulmonary artery banding J. Thorac. Cardiovasc. Surg., May 1, 2006; 131(5): 1130 - 1135. [Abstract] [Full Text] [PDF]