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Pulmonary Artery Banding for Children With Dilated Cardiomyopathy: US Experience
Zachary A Spigel1, Anees Razzouk2, John J Nigro3
1Baylor College of Medicine and Texas Children's Hospital, Houston, Texas.
Insights
Pulmonary artery banding shows promise for dilated cardiomyopathy. Outcomes varied between US and German centers, possibly due to patient preoperative status, highlighting the need for further research in patient selection.
Area of Science:
- Cardiology
- Pediatric Cardiac Surgery
- Heart Failure Management
Background:
- Pulmonary artery banding is an emerging therapy for dilated cardiomyopathy with preserved right ventricular function.
- Initial reports originated from Germany, prompting a need to evaluate its efficacy in other regions.
Purpose of the Study:
- To present the multicenter retrospective experience with pulmonary artery banding in the United States.
- To compare US outcomes with previously reported German data.
Main Methods:
- A retrospective review of 14 patients who underwent pulmonary artery banding across five US centers.
- Comparison of preoperative characteristics and outcomes between US and German cohorts.
Main Results:
- The US cohort (n=14) had a median age of 5 months; 75% required mechanical ventilation and 93% used inotropes preoperatively.
- Outcomes included 29% cardiac recovery, 57% bridged to transplant (6 with VAD), and 14% mortality.
- The US cohort had a lower recovery rate (<1/3) compared to Germany (>2/3), potentially linked to sicker preoperative status (75% intubated vs <33%).
Conclusions:
- Pulmonary artery banding can serve as a bridge to transplant or facilitate recovery in pediatric dilated cardiomyopathy.
- Differences in outcomes between US and German centers may reflect variations in patient selection and preoperative disease severity.
- Further investigation is needed to optimize patient selection and timing for pulmonary artery banding.
Abstract:
Pulmonary artery band placement is a recently described therapeutic strategy for dilated cardiomyopathy with preserved right ventricular function, originally reported from Germany.1 We present the results of the multicenter retrospective study of pulmonary artery band experience in the United States, with comparison to the German experience. Five centers contributed a total 14 patients (median age 5 months, interquartile range 3.5-10). Mechanical ventilation was required in 9/12 (75%) patients and inotropes were used in 13/14 (93%) patients preoperatively. Ultimately, 4 (29%) patients experienced cardiac recovery, 8 (57%) were bridged to cardiac transplantation (6 with ventricular assist device placement), and 2 (14%) died. Although both the US and Germany series demonstrated high prevalence of achieving patients' individual target (either cardiac recovery or transplant), the mode of success was different (recovery rate: <1/3 in the United States and >2/3 in Germany). Lower recovery rate may be a reflection of sicker preoperative status, and thereby a more advanced stage of heart failure (preoperative intubation: >2/3 in the United States vs <1/3 in Germany). Further studies would be warranted to gain more insight into patient selection as well as optimal timing for the intervention.
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