A method of transcutaneously adjustable pulmonary artery banding for staged left ventricular retraining

ObjectivesThe placement of a pulmonary artery band to retrain the left ventricle often requires reoperation for band adjustment. We describe an effective technique for the placement of a transcutaneously adjustable pulmonary artery band that allows adjustments to be made without the need for repeat sternotomy.MethodsUsing standard catheters, an adjustable band was fashioned and placed around the pulmonary artery with the control end positioned in the subcutaneous tissue of the anterior chest wall. Tightening or loosening of the band can be subsequently performed by exposing the control end without the need for reopening the chest.ResultsFrom 1995 to 2011, 11 patients underwent placement of a transcutaneously adjustable pulmonary artery band for the purpose of retraining the morphologic left ventricle for a subsequent arterial switch operation. One or more band adjustments were required in 6 patients (1 loosened and 5 tightened, 55%) at a mean of 281 days (median, 98; range, 0-917) after initial band placement. All were accomplished successfully by exposing the band in the subcutaneous tissue of the anterior chest wall and performing the adjustment under Doppler echocardiographic guidance.ConclusionsThis technique affords the operating surgeon the freedom to apply the band very gradually, erring on the side of safety, and facilitates a gradual increase in ventricular afterload that can be performed as a minor procedure.