Pacella Jonathan, Goldstein Bryan H, McGovern Eiméar, Shahanavaz Shabana, Hirsch Russel, Lehenbauer David, Winlaw David, Morales David L S, Batlivala Sarosh P
Heart Institute, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA.
Heart Institute, UPMC Children's Hospital of Pittsburgh and Department of Pediatrics, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA.
Catheter Cardiovasc Interv. 2025 Jul;106(1):663-673. doi: 10.1002/ccd.31595. Epub 2025 May 19.
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.
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.
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%.
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.
历史上，双侧肺动脉环扎术（PAB）的实施是通过包括体循环血压（BP）和动脉血氧饱和度在内的肺血流替代指标来指导的。仅依靠这些指标可能导致双侧肺动脉环扎术（bPAB）的放置效果欠佳。我们采用一种混合肺动脉环扎术（hPAB），利用压力导丝评估来评估肺血流动力学并指导手术。
对2015年8月至2022年5月期间连续接受混合bPAB手术的患者进行单中心回顾性研究。手术包括主肺动脉（PA）血管造影和选择性PA压力导丝评估，并记录主动脉压力和动脉血氧饱和度。
23例患者接受了hPAB手术。手术中位时间为190分钟[范围122 - 480分钟]。10例患者对PA环扎带共进行了15次调整，其中6次（40%）仅基于压力评估，压力过低且无搏动。5例患者在hPAB术后接受了13次PA干预，其中12次（92%）为经导管干预，1次（8%）为手术干预。2例患者在过渡期接受了分支PA环扎带的经导管血管成形术，4例患者在后续手术后共接受了10次基于导管的PA干预，术后中位时间为7天[范围7 - 270天]。2例患者接受了PA支架植入。分支PA的Z值在出生时正常，在幸存者的最近一次随访（46个月）时仍保持正常，最终PA对称性（较小/较大PA面积×100）为91%±9%。
在混合bPAB手术过程中，压力导丝数据比单独使用传统指标能识别出更多环扎带限制过度的患者。许多幸存者需要未来进行PA干预，且所有患者均显示双侧PA生长和对称性良好。
