Optimal Circumference Size of Pulmonary Artery Band in Functional Single Ventricles with Unrestricted Pulmonary Blood Flow

F. Shikata¹, N. Oka², T. Okamura³, R. Kondo⁴, K. Matsui⁵, T. Hataoka⁶, S. Horie⁷, S. Ishikawa⁴, T. Kitamura⁴, K. Miyaji^7
1Kitasato University, Sagamihara City, KNG ²Jichi Children's Medical Center Tochigi, Shimotsuke, Tochigi, Tochigi ³Gunma Children's Medical Center, Tokyo, Gumma ⁴Kitasato University School of Medicine, Sagamihara, Kanagawa ⁵Jichi Children's Medical Center Tochigi, Shimotsuke, Tochigi ⁶Gunma Children's Medical Center, Shibukawa, Gumma ⁷Dept. of Cardivascular Surgery, Kitasato University School of Med, Sagamihara, Kanagawa

Purpose: To determine the optimal circumference size of pulmonary artery banding (PAB) in functional single ventricles with unrestricted pulmonary blood flow, based on long-term outcomes of the Fontan procedure.

Methods: We analyzed data from 46 patients who underwent PAB as the initial palliative procedure for functional single ventricles with unrestricted pulmonary blood flow at three centers from 2004 to 2020. Patients who underwent bilateral PAB were excluded. PAB tapes were created using a 3.5mm Gore-Tex tube, with the diameter adjusted based on Trusler's formula to achieve a target average pulmonary artery pressure of less than 20 mmHg and an echocardiographic flow velocity at the PAB site of more than 3 m/sec. We examined the association between catheterization data, Fontan-associated liver disease (FALD), and protein-losing enteropathy (PLE), using the Fine-Gray method. Continuous variables were expressed as median + IQR.

Results: The median age and weight at PAB were 22 days (7-41), 2.9 kg (2.5-3.4), respectively. Patients were divided into two groups based on PA band circumference: ≤ BW+17mm (T, 17 patients) and > BW+17mm (L, 29 patients). The T group achieved BCPC significantly earlier (BCPC achieved rate at 6 months old T: 62% vs L: 24%, P=0.02). No differences were observed between groups in PA index, pulmonary artery pressure, SVEDP, and AVVR before BCPC. The TCPC completion rate was similar between the groups (T: 86% vs L: 89%, P=0.99). The T group showed a trend towards lower PVR before TCPC (T: 1.2 (0.8-2.1) vs L: 1.8 (1.5-2.0) U･m2, P=0.06) and had significantly shorter chest tube drainage duration after TCPC (T: 7 (4-9) vs L: 9 (7-17) days, P=0.03). At the 5-year postoperative catheterization, T group had significantly lower pulmonary artery pressure (T: 8 (7-9) vs L: 10 (8-11) mmHg, P=0.02). Fib-4 index values, markers of liver fibrosis, were significantly lower in T group 2-3 years after TCPC (T: 2 years 0.10 (0.07-0.11), 3 years 0.14 (0.10-0.17) vs L: 0.16 (0.12-0.21), 0.17 (0.15-0.28), P=0.004). The cumulative incidence of FALD after TCPC was significantly lower in the T group (0% vs18.9%, P=0.04).

Conclusion: For functional single ventricles with unrestricted pulmonary blood flow, PAB with a circumference ≤ BW+17mm may lead to earlier BCPC and better long-term outcomes after TCPC.

Identify the source of the funding for this research project: none