Christiaan Barnard Division of Cardiothoracic Surgery, Red Cross Children's Hospital, University of Cape Town, Cape Town, South Africa.
Eur J Cardiothorac Surg. 2012 Feb;41(2):272-6. doi: 10.1016/j.ejcts.2011.05.053. Epub 2011 Dec 12.
We examined whether the socio-economic circumstances of a developing country justify pulmonary artery banding (PAB) for the deferral of perceived high-risk patients requiring biventricular repair.
A retrospective cohort analysis was done on 143 consecutive patients with ventricular anatomy suitable for a biventricular repair, who had a pulmonary artery band applied between 1 January 2002 and 31 December 2007 as they were considered too high a risk to undergo corrective surgery. The goal in all patients was to lower their risk of definitive surgery by improving their clinical condition. The minimum follow-up period was 2 years with the closing date for data collection being 31 January 2010. The mean weight and age at PAB was 5.34 ± 2.94 kg and 9.9 ± 17.3 months. The endpoints of the study were mortality, interval hospital readmission, growth pattern post-banding, whether or not definitive correction was achieved, and the current follow-up status of uncorrected patients.
The hospital mortality was 8% (n = 12), the inter-stage mortality 21% (n = 30), and the total mortality 29% (n = 42). Positive growth was not shown in 50% following the banding procedure. The mean number of inter-current hospital admissions was 1.5 ± 2 times per patient. At the termination of data collection, after a mean interval of 24.5 ± 14.3 months, debanding and full correction was achieved in 43% (n = 62). In addition to the 29% (n = 42) that were confirmed to be dead, an additional 28% (n = 39) were not corrected and of these almost half were regarded as lost to follow-up. Thus, of the entire cohort of patients, 57% (n = 81) have not achieved definitive correction at the termination of data collection.
A strategy of deferring biventricular repair by the application of a pulmonary artery band is ineffective under Third World conditions largely due to lack of patient compliance. This study shows that the overall mortality in the inter-stage period following PAB is high prior to definitive correction. Less than half of patients will eventually be repaired in a reasonable time frame and patient follow-up is unreliable. We conclude that consideration should be given to early definitive repair even in perceived high-risk cases.
我们研究发展中国家的社会经济情况是否合理，是否有必要对需要双心室修复的高危患者进行肺动脉带环术（PAB）以推迟手术。
对 2002 年 1 月 1 日至 2007 年 12 月 31 日期间因被认为手术风险过高而接受肺动脉带环术的 143 例心室解剖适合双心室修复的连续患者进行回顾性队列分析。所有患者的目标都是通过改善临床状况降低确定性手术的风险。最小随访期为 2 年，数据收集截止日期为 2010 年 1 月 31 日。肺动脉带环时的平均体重和年龄为 5.34 ± 2.94kg 和 9.9 ± 17.3 个月。研究的终点是死亡率、住院期间再入院率、带环后生长模式、是否进行确定性矫正以及未矫正患者的当前随访情况。
院内死亡率为 8%（n=12），中期死亡率为 21%（n=30），总死亡率为 29%（n=42）。带环后 50%的患者未显示出正向生长。平均每位患者有 1.5 ± 2 次住院期间再入院。在数据收集结束时，平均随访 24.5 ± 14.3 个月后，43%（n=62）患者行脱环和完全矫正。除了 29%（n=42）已确认死亡的患者外，还有 28%（n=39）未得到矫正，其中近一半患者被认为失访。因此，在数据收集结束时，整个患者队列中，57%（n=81）未得到确定性矫正。
在第三世界国家，通过应用肺动脉带环术推迟双心室修复的策略效果不佳，主要原因是患者不配合。本研究表明，在进行确定性矫正之前，PAB 后中期死亡率很高。不到一半的患者最终将在合理的时间内得到修复，而且患者随访不可靠。我们的结论是，即使在高风险患者中，也应考虑早期进行确定性修复。
