| Pulmonary artery banding: still a valuable option in developing countries? | |
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MedLine Citation:
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PMID: 21733709 Owner: NLM Status: Publisher |
Abstract/OtherAbstract:
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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. |
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Authors:
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Andre Brooks; Agneta Geldenhuys; Liesl Zuhlke; Paul Human; Peter Zilla |
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Publication Detail:
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Type: JOURNAL ARTICLE Date: 2011-7-4 |
Journal Detail:
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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:
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Created Date: 2011-7-7 Completed Date: - Revised Date: - |
Medline Journal Info:
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Nlm Unique ID: 8804069 Medline TA: Eur J Cardiothorac Surg Country: - |
Other Details:
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Languages: ENG Pagination: - Citation Subset: - |
Copyright Information:
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Copyright © 2011 European Association for Cardio-Thoracic Surgery. Published by Elsevier B.V. All rights reserved. |
Affiliation:
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Christiaan Barnard Division of Cardiothoracic Surgery at Red Cross Children's Hospital, University of Cape Town, Cape Town, South Africa. |
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From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
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