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Pulmonary artery banding: still a valuable option in developing countries?
MedLine Citation:
PMID:  21733709     Owner:  NLM     Status:  Publisher    
Abstract/OtherAbstract:
Objective: We examined whether the socio-economic circumstances of a developing country justify pulmonary artery banding (PAB) for the deferral of perceived high-risk patients requiring biventricular repair. Methods A retrospective cohort analysis was done on 143 consecutive patients with ventricular anatomy suitable for a biventricular repair, who had a pulmonary artery band applied between 1 January 2002 and 31 December 2007 as they were considered too high a risk to undergo corrective surgery. The goal in all patients was to lower their risk of definitive surgery by improving their clinical condition. The minimum follow-up period was 2 years with the closing date for data collection being 31 January 2010. The mean weight and age at PAB was 5.34±2.94kg and 9.9±17.3 months. The endpoints of the study were mortality, interval hospital re-admission, growth pattern post-banding, whether or not definitive correction was achieved, and the current follow-up status of uncorrected patients. Results: The hospital mortality was 8% (n=12), the inter-stage mortality 21% (n=30), and the total mortality 29% (n=42). Positive growth was not shown in 50% following the banding procedure. The mean number of inter-current hospital admissions was 1.5±2 times per patient. At the termination of data collection, after a mean interval of 24.5±14.3 months, debanding and full correction was achieved in 43% (n=62). In addition to the 29% (n=42) that were confirmed to be dead, an additional 28% (n=39) were not corrected and of these almost half were regarded as lost to follow-up. Thus, of the entire cohort of patients, 57% (n=81) have not achieved definitive correction at the termination of data collection. Conclusion: A strategy of deferring biventricular repair by the application of a pulmonary artery band is ineffective under Third World conditions largely due to lack of patient compliance. This study shows that the overall mortality in the inter-stage period following PAB is high prior to definitive correction. Less than half of patients will eventually be repaired in a reasonable time frame and patient follow-up is unreliable. We conclude that consideration should be given to early definitive repair even in perceived high-risk cases.
Authors:
Andre Brooks; Agneta Geldenhuys; Liesl Zuhlke; Paul Human; Peter Zilla
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Publication Detail:
Type:  JOURNAL ARTICLE     Date:  2011-7-4
Journal Detail:
Title:  European journal of cardio-thoracic surgery : official journal of the European Association for Cardio-thoracic Surgery     Volume:  -     ISSN:  1873-734X     ISO Abbreviation:  -     Publication Date:  2011 Jul 
Date Detail:
Created Date:  2011-7-7     Completed Date:  -     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  8804069     Medline TA:  Eur J Cardiothorac Surg     Country:  -    
Other Details:
Languages:  ENG     Pagination:  -     Citation Subset:  -    
Copyright Information:
Copyright © 2011 European Association for Cardio-Thoracic Surgery. Published by Elsevier B.V. All rights reserved.
Affiliation:
Christiaan Barnard Division of Cardiothoracic Surgery at Red Cross Children's Hospital, University of Cape Town, Cape Town, South Africa.
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