Pulmonary artery banding: when is the use of a telemetrically adjustable device indicated?

Proponents of a telemetrically adjustable pulmonary artery band (PAB) device have cited simplified postoperative management and shortened length of stay as advantages associated with that technology. This report concerns a recent experience with both conventional pulmonary artery banding (conv-PAB) and the telemetrically adjustable PAB FloWatch (FW-PAB). From January 2005 through December 2008, 19 consecutive infants underwent either conv-PAB (8 patients, mean age 3.5 months, mean weight 4.1 kg) or FW-PAB (11 patients, mean age 2.6 months, mean weight 3.1 kg). Indications for PAB were left ventricular retraining (1 patient in FW-PAB), palliation prior to biventricular repair (7 patients in conv-PAB and 10 in FW-PAB group), and staged univentricular repair (1 patient in conv-PAB). In-hospital mortality was 0%. In the FW-PAB group, 1 FloWatch device was removed because of hemodynamic compromise related to the bulk of the device. There were no major complications in the conv-PAB group and no differences between groups with respect to postoperative ventilation time or length of stay in the intensive care unit or in hospital. In the FW-PAB group, a mean of 3.1 ± 1.7 regulations per patient were undertaken. Of the regulations, 85% (29/34) were adjustments to tighten the device, and 15% (5/34) were to loosen it. During follow-up, 8 patients underwent intracardiac repair and pulmonary artery debanding: 4 in the conv-PAB group and 4 in the FW-PAB group. The course of patients in both groups after PAB were similar. Major differences in length of stay and resource utilization were not apparent.