Association Between Initial Pulmonary Artery Band Circumference and Early and Late Outcomes in Single-Ventricle Patients.

Abstract

This study aimed to determine the optimal circumference of pulmonary artery banding (PAB) in functional single ventricles with unrestricted pulmonary blood flow, on the basis of long-term Fontan outcomes. The study analyzed 46 patients who underwent PAB for functional single ventricles at 3 centers from 2004 to 2020. PAB tapes were made using a 3.5-mm expanded polytetrafluoroethylene tube (Gore-Tex tube, W.L. Gore & Associates), with the circumference adjusted to achieve pulmonary artery pressure lower than 20 mm Hg and velocity ≥3 m/s. Patients were divided into 2 groups on the basis of band circumference: less than or equal to body weight + 17 mm (group T; n = 16) and greater than body weight + 17 mm (group L; n = 28). Hemodynamic and surgical outcomes were analyzed. The median age and weight at PAB were 20 days (interquartile range, 7-40 days) and 2.9 kg (interquartile range, 2.5-3.3 kg). Heterotaxy was present in 10 patients (22.7%). Group T had a higher rate of bidirectional cavopulmonary connection at 6 months (84.6% vs 32.1%; P = .015), had shorter chest drainage (7 days vs 10 days; P = .02), and had lower Fontan-associated liver disease incidence at 10 years (0% vs 18.9%; P = .04). No significant differences were found in protein-losing enteropathy incidence. Damus-Kaye-Stansel procedure and pulmonary artery plasty rates were similar between the groups (T, 12.5% and 10.7% vs L, 11.7% and 13.8%; P = .85 and P = .84, respectively). PAB with a circumference less than or equal to body weight + 17 mm was associated with earlier bidirectional cavopulmonary connection and reduced Fontan-associated liver disease risk, and it did not increase the need for additional procedures such as the Damus-Kaye-Stansel procedure or pulmonary artery plasty, thus supporting its safety and efficacy.