Lasso technique for bilateral pulmonary arterial banding

TL;DR

This paper presents a lasso technique for bilateral pulmonary arterial banding in infants, showing it is technically simple and effective for adjusting pulmonary artery diameter.

Contribution

The novel use of a lasso technique with a Gore-Tex suture for bil.PAB is described, enabling precise and adjustable banding.

Findings

The lasso technique allows fine adjustments and reduces residual stenosis in bilateral pulmonary arterial banding.

Readjustment was required in 7 out of 55 cases, all involving further tightening.

Only 2 cases required surgical augmentation at the banding site during follow-up.

Abstract

Bilateral pulmonary arterial banding (bil.PAB) is used as the initial palliative operation for patients with univentricular and biventricular physiology, particularly in smaller patients and in those with multiple comorbidities. Our goal was to report the midterm results of the lasso technique for bil.PAB.

The bilateral pulmonary artery (PA) was encircled with a lasso created using a Gore-Tex suture CV-4. The banding diameter was adjusted via a tourniquet using transoesophageal echocardiography to achieve a luminal diameter of 1.5 mm. From 2017 onward, 55 consecutive patients underwent bil.PAB via this technique.

Median age/body weight was 7 days/2.9 kg, and 21/34 patients exhibited biventricular physiology/univentricular physiology, respectively. The median follow-up period was 2.7 years. The median luminal diameter and flow velocity of the right/left PA at the banding site were 1.4/1.4 mm and 3.0/3.3 m/s, respectively. Readjustment was required in 7 cases, all involving further tightening. The median interval between banding and de-banding was 3.0/1.2 months (biventricular/univentricular). Upon de-banding, adequate dilation was achieved after lasso removal and bougie dilation. During follow-up, 11 patients (20%) required PA augmentation for a hypoplastic central PA. Only 2 cases required surgical augmentation at the banding site in the late or interstage phase.

The lasso technique is technically simple and allows fine adjustments in bil.PAB. A narrower banding width reduces residual stenosis and supports PA growth.

Bilateral pulmonary arterial banding (bil.PAB) has been established as the initial palliative operation for univentricular repair in patients with hypoplastic left heart syndrome (HLHS) and its variants [1–5].

Figures