Evaluation of Ain Shams University Hospitals Clinical Pathway for Pulmonary Artery Banding

Abstract

Abstract Background Pulmonary artery banding (PAB) remains a useful surgical palliation for small neonates and early infants with excessive pulmonary blood flow who are unable or difficult to withstand an open heart surgery using cardiopulmonary bypass or in developing countries where the facilities not suitable for primary corrective surgery in those infants. Objectives In our current study we aimed to study clinical pathway of cases underwent PAB at ASU hospital pediatric cardiac surgery department with discussion of different causes of mortality and morbidity. Patients and Methods Study done by data collection retrospectively of 50 patients underwent pulmonary artery banding in the period from January 2018 to December 2019 who fulfilling the inclusion criteria with evaluation of different clinical pathways for the outcome mainly morbidities and mortality. Results We found that the major risk factors of mortality in cases underwent PAB in ASU hospitals includes patients diagnosed with TGA, low preoperative so2 ≤85, ventilation is high risk factor for mortality so it is recommended to extubate those patients on table or shortly after discharge to ICU as soon as possible, duration of intubation: the longer the duration of intubation, the higher the mortality, postoperative PG across band ≤45.that indicator for a loose band with still persistent pulmonary overflow, re-intubation, post operative morbidities are highly associated with mortality, 11 out of 12 mortality cases suffered from postoperative complications (91.7 % of mortality cases) that includes poor chest condition, stroke, postoperative convulsions and pulmonary hemorrhage. These morbidities result in prolonged intubation and prolonged ICU stay. Conclusion Pulmonary artery banding is palliative procedure done in infants with pulmonary artery overflow with unprotected pulmonary circulation in variable congenital cardiac diseases (VSD, single ventricle, TGA) as a primary stage for total repair when the infant gain weight and get older, the suitable age for banding is < 6 months.