Results of Pulmonary Artery Debanding: Simple Band Removal Versus Pulmonary Artery Repair with Pericardial Patch

Abstract

Background: Among the complications noted after debanding is those related to residual pulmonary stenosis. Removal of band without repairing pulmonary artery could be enough. Others recommend patching pulmonary artery at the site of band during debanding because of possibility of residual gradient caused by a residual shelf or narrowing and distortion of the arterial wall. This may necessitate re-operation especially if it leads to pressure over-load on the right ventricle.Objective: To compare between simple band removal and band removal with pulmonary artery repair using pericardial patch, at time of debanding; concerning early postoperative pressure gradients across the main pulmonary artery. Patients and methods: This retrospective observational study included 40 patients who underwent pulmonary artery debanding in the period between January 2016 and January 2020 at the Cardiothoracic Surgery Department, Cairo University hospitals and Atfal Masr Hospital. Patients were divided into two groups; group A, which included 20 patients who underwent simple band removal and group B, which included 20 patients who underwent pulmonary artery debanding with pericardial patch repair. Results:The median pressure gradient across the main pulmonary artery postoperatively was 15 mm Hg for group A (mean 22.58±18.0) and 10 mm Hg for group B (mean 11.3±8.0) with statistically significant value (p=0.020). 40.0% of cases in Group A had significant residual pressure gradient compared to only 10.0% of cases in Group B, and that difference was statistically significant (p=0.028). The median pressure gradient across the band immediate preoperatively was 60mmHg for group A (mean 62.0±9.8) and 70mmHg (mean 64.2±10.6) with statistically insignificant value (p=0.065). Conclusion: Pulmonary artery repair with pericardial patch showed the advantage of reducing the risk of significant residual pressure gradient across the band site over simple band removal in pulmonary artery debanding.