Abstract
OBJECTIVE: Although pulmonary artery banding (PAB) seems to be a technically simple procedure it presents several peculiarities and is related to a significant morbidity and mortality. The aim of this study is to analyze the experience of a tertiary hospital on the PAB by assessing and correlating many aspects related to the procedure. METHODS: Between January 2000 and December 2008, 61 patients undergone PAB due to congenital heart disease with increased pulmonary blood flow at Messejana Heart Hospital were assessed as for mortality, complications, stay in mechanical ventilation and need for intensive care unit (ICU), use of vasoactive drugs, difficulties in the adjustment on the banding and reoperations. Some statistical analyzes were performed to compare the subgroups. RESULTS: In 46.8% of the patients the intended pressoric adjustment was not achieved and in 6.5% it was necessary another surgery to readjust the banding. The mean time of mechanical ventilation was 14.1±49.6 days and ICU 14.16±10.92 days. In 82.6% of the patients vasoactives drugs were administrated for 10.3±12.79 days. Severe complications were noted in 49.15% of patients and cardiac insufficiency was the most common one with an incidence of 44%. The mortality rate was 8.2% and it was not influenced by weight or associated procedures with the PAB neither if univentricular or biventricular heart disease. CONCLUSION: The PAB can be performed with acceptable mortality rates compatible with the ones of the world literature. Nevertheless, the adjustment of the banding is difficult to be assessed during the surgery by making the procedure complex and justifying the high incidence of complications and long stay in ICU. It wasn't found any specific risk factor significant to mortality neither uni- or biventricular heart disease
Highlights
Since the initial proposition of Muller and Danimann [1] in 1952, the techniques for surgical creation of an obstruction to pulmonary flow have evolved, as well as its clinical indications
The mortality rate was 8.2% and it was not influenced by weight or associated procedures with the pulmonary artery banding (PAB) neither if univentricular or biventricular heart disease
The PAB can be performed with acceptable mortality rates compatible with the ones of the world literature
Summary
Since the initial proposition of Muller and Danimann [1] in 1952, the techniques for surgical creation of an obstruction to pulmonary flow have evolved, as well as its clinical indications. What could be considered a simple surgery - the pulmonary artery banding (PAB) – is currently still accompanied by high morbidity and mortality, with significant complication rates [2,3,4]. This fact is due to the difficulty of assessing the degree of pulmonary constriction to be produced, considering that this assessment is performed in very special circumstances, since the patient is under general anesthesia, muscle relaxant, with the chest opened and ventilation controlled. A stenosis produced by a constriction of the pulmonary artery (PA) which presents, by external inspection, as mild or moderate, may represent a much greater luminal narrowing due to the invagination of the vessel wall to its lumen, producing a greater obstruction than expected
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