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, Simon P. McGuirk, Christian Balmer, Stephen M. Langley, Massimo Griselli, Oliver Stümper, Joseph V. De Giovanni, John G. Wright, Sara Thorne, David J. Barron, William J. Brawn

    Research output: Contribution to journalArticle

    82 Scopus citations

    Abstract

    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.

    Original languageEnglish (US)
    Pages (from-to)405-411
    Number of pages7
    JournalCirculation
    Volume111
    Issue number4
    DOIs
    StatePublished - Feb 1 2005

    Keywords

    • Heart defects, congenital
    • Surgery
    • Transposition of great vessels

    ASJC Scopus subject areas

    • Cardiology and Cardiovascular Medicine
    • Physiology (medical)

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  • Cite this

    Winlaw, D. S., McGuirk, S. P., Balmer, C., Langley, S. M., Griselli, M., Stümper, O., De Giovanni, J. V., Wright, J. G., Thorne, S., Barron, D. J., & Brawn, W. J. (2005). 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. Circulation, 111(4), 405-411. https://doi.org/10.1161/01.CIR.0000153355.92687.FA