Pulmonary artery banding as 'open end' palliation of systemic right ventricles: an interim analysis

A morphological right ventricle (RV) is not ideally suited for the long-term maintenance of the systemic circulation. The aim of this analysis was to evaluate the intermediate results and outcome of pulmonary artery banding (PAB) in an open-ended strategy. This is a retrospective review of patients with systemic RVs who had undergone PAB in our institution from April 1985 to January 2011. PAB was placed in 5 patients late after the Senning operation and in 15 patients with corrected transposition; of whom, 6 had a large ventricular septal defect. PAB was performed at a median age of 4.3 years (range: 0.9-14.9), median follow-up of 86 months (range: 0.5-379). All 20 patients are alive and are being followed up. Tricuspid regurgitation (TR), RV function and dilation showed no deterioration after banding (P = 0.9). Ninety per cent (18/20) have adequate ongoing palliation with PAB. One patient underwent a double-switch operation and one received an additional bidirectional Glenn shunt. A dilatable band was redilated with improvement in percutaneous saturation and in another the procedure was abandoned due to development of transient atrioventricular block. Functional class remained either unchanged or improved. PAB was performed with no mortality and low morbidity. PAB in these heterogeneous patients provides true 'open ended palliation' by allowing left ventricular training in those going for anatomical repair, stabilizing or improving RV function and TR in others, thereby delaying surgery. It can also be left in place as long-term palliation. The addition of a dilatable band allows manipulation of pulmonary flows, but longer follow-up is required to provide data on best management strategies for these complex patients.