Upper mini sternotomy approach for pulmonary artery banding: A single centre experience

Abstract

Background: Pulmonary artery banding (PAB) remains a crucial technique in modern cardiac surgery. Left lateral thoracotomy, median sternotomy, and left anterior thoracotomy are well-known approaches. With significant scarce reports addressing the application of the upper mini sternotomy approach for PAB, this study aims to share experience and report outcomes of patients operated upon using this approach and its impact on facilitating the redo surgery.

Miniature Minimally Invasive Pulmonary Banding in Neonates (MINI-MICS): A Novel Technique

“…Pulmonary artery banding is still used in critical and highrisk patients as part of the hybrid "Giessen approach" as the first stage of HLHS. [8][9][10][11] Despite the multiple surgical procedures expected with single-ventricle physiology, avoiding the sternum during the first procedure at the neonates' most delicate stage of development not only allows a less traumatic first procedure but permits a less manipulated mediastinum and a virgin sternum for the consequent surgery to come. This technique is reproducible in experienced hands and shows favorable and promising results if properly performed.…”

“…Current indications also include HLHS as part of a hybrid approach either as a first-stage palliation or as a bridging therapy to a Norwood procedure in high-risk and low-weight neonates. [9][10][11] The surgical technique used may vary slightly depending on the attending surgeon and associated cardiac or vascular defects. Approaches include the traditional sternotomy, left thoracotomy, ministernotomy, or, as in our center, the left parasternal minithoracotomy (MINI-MICS).…”

“…In addition, pulmonary arterial pressures should remain between 30% and 50% of the systemic pressure, and rhythm abnormalities should be avoided or quickly corrected while avoiding hypotension. 6–11 Throughout the years, a variety of techniques have been introduced to perform pulmonary artery bandings. These include external bandings, the use of absorbable materials, bandings performed by interventional cardiology, and, more recently, the FloWatch ® device.…”

“…Current indications also include HLHS as part of a hybrid approach either as a first-stage palliation or as a bridging therapy to a Norwood procedure in high-risk and low-weight neonates. 9–11…”