Pulmonary artery banding (PAB) remains an important palliative strategy in selected congenital cardiac patients. Traditionally, it is performed through a median sternotomy, which provides excellent exposure but may increase surgical trauma and complicate later reentry. An upper ministernotomy offers a less invasive alternative, and the authors published experience in cardiac surgery shows that this access can provide adequate central exposure while preserving the lower sternum and reducing dissection of the anterior mediastinum.
This video presents the use of an upper ministernotomy for pulmonary artery banding (PAB) as a practical and efficient approach. The technique allows for the direct visualization of the great vessels with standard operative conduct while avoiding a full sternotomy. Based on the established benefits of upper ministernotomy in other cardiac procedures, this access may decrease operative trauma, postoperative pain, bleeding, and wound-related morbidity, while also offering a cosmetic advantage.
A further potential benefit is the preservation of sternal integrity and reduced mediastinal scarring, which may facilitate a later redo sternotomy when definitive repair is required. This is especially relevant in staged congenital surgery, where future reentry is anticipated. Upper ministernotomy, therefore, appears to be a useful and reproducible option for pulmonary artery banding in carefully selected patients, combining minimal invasiveness with preserved readiness for subsequent surgery.
This video features the case of an infant with a complete atrioventricular septal defect who underwent PAB via an upper ministernotomy at three months of age, followed seven months later by definitive repair using the standard two-patch technique.
The PAB was successfully performed through a limited upper ministernotomy in a 3.2 kg infant. Despite the small incision, a well-seated and effective band was placed efficiently, with the patient remaining hemodynamically stable throughout the procedure and undergoing successful fast-track extubation. At the time of definitive repair, the sternum was reopened using scissors without difficulty, and the loose mediastinal adhesions were easily dissected. The reentry time, defined as the interval from skin incision to systemic heparinization, was only 22 minutes, followed by a standard repair of the complete atrioventricular septal defect.
References
- Salem A, Walley H, Khaymaf D, Shaban A, Hussain-Alkhateeb L. Upper mini sternotomy approach for pulmonary artery banding. J Card Surg. 2021;1–5.
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