Conventional versus Adjustable Pulmonary Artery Banding: Which is Preferable?

A best evidence topic in cardiac surgery was written according to a
structured protocol. The question addressed was ‘whether conventional
pulmonary artery banding (PAB) or adjustable PAB might be the superior
intervention?’ Using the PubMed search, 51 papers were found, of which
seven papers represented the best evidence to answer the clinical
question. We included only those papers that actually compared
conventional PAB with adjustable PAB, and excluded those that studied
only one of these interventions. Four studies qualified (one prospective
and three retrospective) and analysed data in human patients, while
three were experimental studies in animals. The end points in the
prospective human study were death, debanding and follow-up to
intracardiac repair. The three retrospective studies compared the
incidence of early deaths, inotropic support, need for mechanical
ventilatory support, reoperations and intensive care unit and hospital
stay. Out of the four studies in humans, three studies noted a
significant reduction in early deaths from 23 to 1.8%, 77 to 0% and 15
to 0% in conventional vs adjustable PAB. Need for early reoperations
reduced from 18 to 3.5% and from 35 to 0% in 2 studies. Similarly, there
was a reduction in the ventilatory times and the intensive care unit
and hospital stay. The three experimental animal studies demonstrated
that a much more reliable preparation of the ventricle was achieved with
the use of an adjustable PAB. The results of all the seven studies led
us to conclude that adjustable PAB provides superior early outcomes;
reduces early mortality, need for inotropes and need for reintervention;
and provides equivalent or superior band gradients when compared to
conventional PAB. The use of the adjustable PAB was found to result in
significant haemodynamic improvement by progressively reducing the
pulmonary artery pressures and left-to-right shunt. The adjustable PAB
was found to improve early survival and also made delayed repair
feasible in a better clinical state, with reduced mortality and
morbidity.