Pulmonary Artery Banding Still Has an Important Role in the Treatmant of Congenital Heart Disease: Reply

Abstract

We thank Dr Yoshimura and colleagues for their comments regarding our article [1Takayama H. Sekiguchi A. Chikada M. Noma M. Ishizawa A. Takamoto S. Mortality of pulmonary artery banding in the current era recent mortality of PA banding.Ann Thorac Surg. 2002; 74: 1219-1224Abstract Full Text Full Text PDF PubMed Scopus (38) Google Scholar] and congratulate them on their excellent results. We showed that there was no improvement in terms of hospital mortality after pulmonary artery (PA) banding in the last decade and suggested that our results may justify the recent trend toward primary repair in accordance with accumulating evidence of better outcome with primary repair. We speculated that the palliative procedure may limit further improvement.It is very encouraging for congenital heart surgeons that Dr Yoshimura and co-workers showed reduction in mortality to essentially 0% after PA banding in the last decade. However, these results could lead us to perform PA banding on patients who potentially could undergo repair at an earlier age.The difference in mortality rates between the two studies, however, could be associated with different durations of observation, which was hospital mortality in our series, and different comorbid conditions. More importantly, we need to know long-term results comparing staged repair with primary repair to prove that PA banding is a “safe” procedure.As we wrote in our article, PA banding still has an important role, and it can be performed with reasonable mortality even in smaller patients. There is no doubt that there is a certain percentage of patients who cannot avoid this procedure. Enthusiastic research continues to seek a better outcome [2Leeuwenburgh B.P. Schoof P.H. Steendijk P. Baan J. Mooi W.J. Helbing W.A. Chronic and adjustable pulmonary artery banding.J Thorac Cardiovasc Surg. 2003; 125: 231-237Abstract Full Text Full Text PDF PubMed Scopus (23) Google Scholar, 3Corno A.F. Bonnet D. Sekarski N. Sidi D. Vouhe P. von Segesser L.K. Remote control of pulmonary blood flow initial clinical experience.J Thorac Cardiovasc Surg. 2003; 126: 1775-1780Abstract Full Text Full Text PDF PubMed Scopus (32) Google Scholar]. In other words, clinicians know that a breakthrough is necessary for better results. Individual studies comparing the different outcomes between primary repair and staged repair may be helpful in further delineating the role of PA banding. We thank Dr Yoshimura and colleagues for their comments regarding our article [1Takayama H. Sekiguchi A. Chikada M. Noma M. Ishizawa A. Takamoto S. Mortality of pulmonary artery banding in the current era recent mortality of PA banding.Ann Thorac Surg. 2002; 74: 1219-1224Abstract Full Text Full Text PDF PubMed Scopus (38) Google Scholar] and congratulate them on their excellent results. We showed that there was no improvement in terms of hospital mortality after pulmonary artery (PA) banding in the last decade and suggested that our results may justify the recent trend toward primary repair in accordance with accumulating evidence of better outcome with primary repair. We speculated that the palliative procedure may limit further improvement. It is very encouraging for congenital heart surgeons that Dr Yoshimura and co-workers showed reduction in mortality to essentially 0% after PA banding in the last decade. However, these results could lead us to perform PA banding on patients who potentially could undergo repair at an earlier age. The difference in mortality rates between the two studies, however, could be associated with different durations of observation, which was hospital mortality in our series, and different comorbid conditions. More importantly, we need to know long-term results comparing staged repair with primary repair to prove that PA banding is a “safe” procedure. As we wrote in our article, PA banding still has an important role, and it can be performed with reasonable mortality even in smaller patients. There is no doubt that there is a certain percentage of patients who cannot avoid this procedure. Enthusiastic research continues to seek a better outcome [2Leeuwenburgh B.P. Schoof P.H. Steendijk P. Baan J. Mooi W.J. Helbing W.A. Chronic and adjustable pulmonary artery banding.J Thorac Cardiovasc Surg. 2003; 125: 231-237Abstract Full Text Full Text PDF PubMed Scopus (23) Google Scholar, 3Corno A.F. Bonnet D. Sekarski N. Sidi D. Vouhe P. von Segesser L.K. Remote control of pulmonary blood flow initial clinical experience.J Thorac Cardiovasc Surg. 2003; 126: 1775-1780Abstract Full Text Full Text PDF PubMed Scopus (32) Google Scholar]. In other words, clinicians know that a breakthrough is necessary for better results. Individual studies comparing the different outcomes between primary repair and staged repair may be helpful in further delineating the role of PA banding.