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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)
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