A new strategy for the surgical treatment of aortic coarctation associated with ventricular septal defect in infants using an absorbable pulmonary artery band

Absorbable pulmonary artery band

OBJECTIVE: In 1996, the Brazilian cardiovascular surgeon, Dr. Randas Batista, introduced a surgical technique called partial left ventriculectomy, where he admitted the possibility of reducing the diameter of the left ventricle through the sectioning of one section of its wall. After the publication of this study, thousands of case reports and procedure analysis have been published, and due to several disappointing results, many doctors and institutions failed to execute it. As the main objective of this study, stands out the search for success cases of ventriculectomy in the last 12 years and if during this period it was achieved some significant development in this procedure that allows obtaining lower mortality rate postoperatively. METHODS: Systematic review of indexed scientific literature over the past 12 years and the term "Partial Left Ventriculectomy". RESULTS: There has been a considerable number of reported successful cases and highly significant findings in regard to determining the most suitable region for the section, proper selection of the patients indicated to the procedure, including the influence of the coronary artery anatomy in the nomination procedure and the need for preservation of ventricular geometry to ensure better quality of ventricular contractions after the sectioning. CONCLUSION: This surgical procedure has been successfully performed, mainly in Japan, improvements in its efficiency were found and the need for a mathematical modeling of the slice to be severed is a prominent factor in many studies.

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Partial Left Ventriculectomy: Have Well-Succeeded Cases and Innovations in the Procedure Been Observed in the Last 12 Years?

Objectives Pulmonary artery banding (PAB) remains in the armamentarium of techniques for several congenital cardiac anomalies, but necessitates a reoperation for eventual removal. We sought to assess the efficacy of an absorbable PAB in obviating the requirement for reoperation. Methods From 2003 to 2015, 45 consecutive patients with a median age of 1.6 months (2 days-11 months) underwent placement of a polydioxanone absorbable PAB. In 28 patients (62%), the band was placed concomitantly to a ventricular septal defect (VSD) closure and in 17 (38%), the band was the sole procedure for the VSDs. Fourteen patients had additional cardiac anomalies and 9 patients had aortic arch anomalies, which were repaired at the time of absorbable PAB placement. Results There was 1 hospital death. The band was removed early in 3 patients. Mean time to follow-up was 5.2 ± 3.5 years. Overall, 32 of the 41 patients discharged from hospital with absorbable PABs did not require reoperation on the VSDs or the band, resulting in a single-stage definitive repair of 78%. Median time to absorbable PAB resorption was 7.2 months (interquartile range, 5.0-10.4). Freedom from reoperation related to residual VSDs or PAB obstruction was 78% (95% CI: 61-87%) at 10 years. Conclusions The use of absorbable polydioxanone PABs is an effective method of reducing reoperations for multiple VSDs. Their use should be incorporated in the surgical strategy for repair of muscular and residual VSDs.

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Absorbable pulmonary artery banding: a strategy for reducing reoperations.

Absorbable pulmonary arterial banding: an optimal strategy for muscular or residual ventricular septal defects.

Since May 1989 we have been using a reabsorbable 3 mm, polidioxanona band for pulmonary banding instead of the dacron one. This procedure was performed in 5 patients with ages between 33 to 230 days. The diagnoses were atrioventricular canal in one case and ventricular septal defect in the other 4 cases. One of them also had vascular ring with right aortic arch, left patent ductus arterious and aberrant subclavian artery. All the patients were in a poor condition. Subsequent reoperations performed in short, medium, and long term were uncomplicated, and the technique had the added benefit of avoiding the need for pulmonary reconstruction. A close ECO Doppler follow-up is necessary to determine the best moment for definitive correction. We think that this new technique makes the banding a reliable and complications free procedure and its place should be reevaluated in the light of the current tendency for early complete correction.

Reabsorbable banding. Our initial experience

A four-month-old infant with anomalous origin of the left coronary artery from the pulmonary artery developed severe left ventricular failure after aortic reimplantation, despite prolonged supportive cardiopulmonary bypass with high level inotropic support and several abortive attempts for discontinuation. The Batista procedure was performed and the patient was successfully weaned from bypass. Postoperative recovery was uneventful, and at one-year follow-up she remains asymptomatic. (J Card Surg 2012;27:114–116)

Use of the Batista procedure to discontinue bypass following aortic reimplantation of an anomalous left coronary artery.

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J. Gutiérrez de Loma

Papers

Reabsorbable banding. Our initial experience

Use of the Batista procedure to discontinue bypass following aortic reimplantation of an anomalous left coronary artery.

Pseudoaneurisma gigante de fístula arteriovenosa humeral autóloga: reparación quirúrgica