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Cardiothoracic Surgery Publication Brief: (10278AHKotani) The Utility of Aortic Blood Flow Measurements in the Prediction of Pulmonary Artery Banding Outcome Division of Cardiovascular Surgery, The Labatt Family Heart Centre, The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada. Background Pulmonary artery banding (PAB) has been the standard for patients with high pulmonary blood flow awaiting subsequent surgery. The PAB is designed to provide adequate systemic flow by restricting pulmonary flow thus allowing the patient to grow and be a safter candidate for followup surgery. objective The purpose of the study was to evaluate the clinical utility of intraoperative aortic blood flow measurements on clinical outcome in patients undergoing pulmonary artery banding (PAB). METHODS • We reviewed 12 patients who underwent a PAB between September 2008 and March 2013. Diagnosis included biventricular physiology in 6, single-ventricle physiology in 4, and inadequate systemic ventricle in 2 patients. • After mobilization of the ascending aorta and PA, baseline measurements of aortic and PA flows were made directly with an 8- or 10 - mm Transonic Flowprobe. After banding a repeat aortic flow measurement was made. • Aortic flow, intraoperative hemodynamics, and clinical outcomes were analyzed to determine the potential predictive utility of intraoperative variables on postoperative outcomes. RESULTS • Aortic flow increased after PAB from 1.56 ± 0.73 to 2.20 ± 1.10 L · min/m2 (41.0% increase; p = 0.001). • The efficacy of the PAB procedure was found to be directly related to the percentage increase in aortic blood flow measured intraoperatively. • Three patients with less than 20% increase in aortic blood flow either died, required re-PAB, or developed ventricular dysfunction. Patients with successful PAB had more than 40% increase in aortic blood flow. • The percentage increase in aortic blood flow was not predictable based on pre-band or post-band absolute aortic blood flow measurements. The percentage increase in aortic blood flow was inversely correlated to the tightness of the PAB as defined relative to that predicted by the Trusler formula (r = 0.67; p = 0.01). CONCLUSIONS This study identifies the change in the aortic blood flow as a new, physiologically based parameter to help predict PAB outcome. • An increase in aortic blood flow of less than 20% may foreshawdow PAB failure. • An increase in aortic blood flow of more than 40% indicated good outcomes despite relatively loose PAB. The researchers suggest that assessment of the change in aortic blood flow is a useful tool to determine the circulatory response to PAB physiology. Reference Kotani Y, Coles M, D Desai N, Honjo O, Caldarone CA, Coles JG, Van Arsdell GS, “The Utility of Aortic Blood Flow Measurements in the Prediction of Pulmonary Artery Banding Outcome,” Ann Thorac Surg. 2015 Apr 15. (Transonic Reference: 10278AH) Kotani(10278AH-pb)Rev12015USltr