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Antonio F. Corno
Edmund J. Ladusans
Marco Pozzi
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J Thorac Cardiovasc Surg 2007;134:1413-1420
© 2007 The American Association for Thoracic Surgery

Surgery for Congenital Heart Disease

FloWatch versus conventional pulmonary artery banding

Antonio F. Corno, MD, FRCS, FACC, FETCS1,*, Edmund J. Ladusans, MD, FRCP, Marco Pozzi, MD, FRCS, FETCS, Stephen Kerr, MBBS, FRACP

Alder Hey Children Hospital, Liverpool, England.

Read at the Eighty-seventh Annual Meeting of The American Association for Thoracic Surgery, Washington, DC, May 5-9, 2007.

Received for publication February 9, 2007; revisions received March 15, 2007; accepted for publication March 22, 2007.

* Address for reprints: Antonio F. Corno, MD, FRCS, FACC, FETCS, Cardiac Surgery, Alder Hey Children Hospital, Eaton Road, Liverpool, L12 2AP, United Kingdom. (Email: Antonio.Corno{at}rlc.nhs.uk).

Objective: We sought to compare the efficacy of conventional pulmonary artery banding with that of FloWatch pulmonary artery banding.

Methods: Forty consecutive infants underwent conventional pulmonary artery banding (n = 20; mean age, 1.8 ± 1.5 months; mean weight, 3.7 ± 0.7 kg) or FloWatch pulmonary artery banding (n = 20; mean age, 2.6 ± 1.3 months; mean weight, 4.1 ± 0.8 kg). Indications were preparation for biventricular repair in 16 of 20 infants, univentricular repair in 2 of 20 infants, and left ventricular retraining in 2 of 20 infants in the conventional pulmonary artery banding group versus 13 of 20, 5 of 20, and 2 of 20 infants, respectively, in the FloWatch pulmonary artery banding group. Twelve of 20 infants required preoperative mechanical ventilation in the conventional pulmonary artery banding group (mean duration, 3.3 ± 4.3 days) versus preoperative mechanical ventilation required by 14 of 20 in the FloWatch pulmonary artery banding group (mean duration, 17.5 ± 19.0 days; P < .005).

Results: There were 3 early and 2 late deaths after conventional pulmonary artery banding (mean follow-up, 10.8 ± 9.6 months; range, 1–33 months) versus no early and 2 late deaths after FloWatch pulmonary artery banding (mean follow-up, 13.4 ± 10.4 months; range, 1–38 months). Postoperative mechanical ventilation and intensive care unit and hospital stays were significantly longer after conventional pulmonary artery banding than those after FloWatch pulmonary artery banding, respectively (10.4 ± 11.2 vs 3.0 ± 3.1 days [P < .01], 20.3 ± 19.9 vs 5.3 ± 4.6 days [P < .005], and 45.6 ± 41.6 vs 15.4 ± 6.4 days [P < .005]). Reoperation to adjust the band was required in 7 (35%) of 20 infants after conventional pulmonary artery banding, whereas no reoperations were required after FloWatch pulmonary artery banding (P < .005). Average cost of stay in the intensive care unit and hospital was, respectively, $45,000 and $45,300 cheaper with FloWatch pulmonary artery banding than average cost with conventional pulmonary artery banding, largely surpassing the cost of the device ($10,000).

Conclusions: FloWatch pulmonary artery banding appears superior to conventional pulmonary artery banding because (1) reoperations are not required; (2) postoperative management is simplified and postoperative mechanical ventilation, stay in the intensive care unit, and stay in the hospital are significantly reduced; and (3) the reduction in costs of postoperative mechanical ventilation, stay in the intensive care unit, and stay in the hospital significantly outweigh the cost of the device.

Abbreviations and Acronyms conv-PAB = conventional pulmonary artery banding; FW-PAB = FloWatch pulmonary artery banding; ICU = intensive care unit; PAB = pulmonary artery banding


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Discussion
J. Thorac. Cardiovasc. Surg. 2007 134: 1419-1420. [Extract] [Full Text] [PDF]



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