Pressure-Wire Guided Hybrid Branch Pulmonary Artery Band Placement for Palliation of Single Ventricle and Critical Congenital Cardiac Lesions.

Abstract

Background: Historically, bilateral pulmonary artery band (PAB) placement was guided by pulmonary blood flow surrogates including systemic blood pressure (BP) and arterial saturation. These metrics alone may result in suboptimal bPAB placement. We perform a hybrid PAB (hPAB) procedure employing pressure-wire assessment to evaluate pulmonary hemodynamics and guide the procedure.

Methods: Single-center retrospective study of consecutive patients that underwent hybrid bPAB procedure between August 2015 and May 2022. Procedures involved main pulmonary artery (PA) angiography and selective PA pressure-wire assessment. Aortic pressure and arterial saturation were recorded.

Results: Twenty-three patients underwent hPAB procedure. Median procedure time was 190 min [range 122-480 min]. Ten patients underwent 15 total adjustments to a PA band, 6 (40%) based solely on pressure assessment with inappropriately low and non-pulsatile pressures. Five patients underwent 13 PA interventions after hPAB, 12 (92%) were transcatheter and 1 (8%) operative. Two patients underwent transcatheter angioplasty of a branch PA band in the interstage period while 4 underwent a total of 10 catheter-based PA interventions after the subsequent operation, at a median of 7 days [range 7-270 days] post-operatively. Two patients underwent PA stent implant. Branch PA Z-scores were normal at birth and remained normal at most recent follow-up for survivors (46 months), with final PA symmetry (smaller/larger PA area × 100) of 91% ± 9%.

Conclusions: Pressure-wire data identified more patients with overly restrictive bands during hybrid bPAB procedures than traditional markers alone. Many survivors required future PA intervention, and all demonstrated appropriate bilateral PA growth and symmetry.