BACKGROUND:
Placement of an extraluminal pulmonary artery band (EL-PAB) is associated with significant complications. This technique can also be associated with difficulties in achieving and maintaining a consistent gradient. When placement of a PAB is required as part of a CPB procedure, we employ an intraluminal (IL-PAB) technique to promote a more consistent outcome with a low complication rate.
METHODS:
We reviewed our experience with 18 patients who required a PAB in addition to other cardiac operations performed on CPB. The IL-PAB consists of a round, fenestrated patch of bovine pericardium or PTFE. The fenestration diameter was 3.5 ± 0.34 mm. This patch is sutured to the inside of the main pulmonary artery just above the sinotubular junction. Data from the pre-banding and pre-debanding heart catheterizations and echocardiograms were analyzed.
RESULTS:
The IL-PAB reduced the systolic PA pressure from 61.2±15 mm Hg to 14.71±5.5 mm Hg (P<0.001). The mean PA pressure dropped from 43.9±12.4 mm Hg to 11.6±3.5 mm Hg (P<0.001). The Qp/Qs fell from 3.5±1.8 to 0.9±0.39 (P=0.04). The PA to aortic pressure ratio decreased from 0.95±0.15 to 0.17±0.06 (P<0.001). None of the survivors experienced a progressive decline in the pressure gradient across the IL-PAB over time. To the contrary, the gradient rose from 64.3±14.6 mm Hg to 82±13.4 mm Hg (P=0.015). There were no complications directly attributable to the IL-PAB's.
CONCLUSIONS:
The IL-PAB produces a consistent and durable reduction of PA pressure with few complications in patients who require CPB for their cardiac surgical palliation.

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