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Published on: March 1, 2022
Midterm Outcomes of Endovascular Pulmonary Artery Debanding in Children
Raymond N Haddad1,2, Nelly Sleiman3, Issam El Rassi4
1Department of Pediatric Cardiology, Hotel Dieu de France University Medical Center, Saint Joseph University, Beirut, Lebanon.
Insights
Endovascular debanding (ED) is a safe, less invasive alternative to surgery for pulmonary artery banding (PAB) complications. This study shows satisfactory midterm outcomes for ED in children, though repeat procedures may be needed.
Area of Science:
- Pediatric Cardiology
- Interventional Cardiology
- Congenital Heart Disease
Background:
- Pulmonary artery banding (PAB) is a palliative procedure to manage pulmonary over-circulation in certain congenital heart conditions.
- Endovascular debanding (ED) presents a minimally invasive option to address complications or the need for PAB reversal, avoiding repeat surgeries.
- Muscular ventricular septal defects (MVSDs) can present challenges in managing hemodynamics, especially following PAB.
Purpose of the Study:
- To evaluate the safety and efficacy of endovascular debanding (ED) in children previously treated with pulmonary artery banding (PAB).
- To assess the midterm outcomes of ED in patients with single, multiple, or "Swiss-cheese" muscular ventricular septal defects (MVSDs).
Main Methods:
- A retrospective review of single-center data from 2015-2023 identified pediatric patients undergoing ED.
- Data collected included patient demographics, PAB history, MVSD characteristics, procedural details (balloon types and sizes), and hemodynamic parameters.
- Outcomes assessed included changes in trans-PAB gradient, oxygen saturation, procedural complications, and need for reintervention.
Main Results:
- Ten patients underwent ED at a median age of 5 years, with a median of 52.8 months post-PAB.
- ED significantly reduced the median trans-PAB gradient from 100 mmHg to 40 mmHg (p < 0.01) and improved oxygen saturation (p < 0.05).
- No procedural complications occurred; however, two patients required repeat ED during a median follow-up of 91.7 months.
Conclusions:
- Endovascular debanding (ED) is a safe procedure for children with pulmonary artery banding (PAB) complications.
- The technique demonstrates satisfactory midterm outcomes, effectively reducing pulmonary artery pressure and improving oxygenation.
- Repeat ED procedures may be necessary in a subset of patients during long-term follow-up.
Background:
Pulmonary artery banding (PAB) palliates pulmonary over-circulation, while endovascular debanding (ED) offers a less invasive alternative to repeat surgery.
Objectives:
To evaluate our experience with ED.
Aims:
Retrospective review of single-center data (2015-2023) on children with single, multiple, or "Swiss-cheese" muscular ventricular septal defects (MVSDs) undergoing ED.
Results:
Ten patients (50% male) underwent ED at a median age of 5 years (IQR, 1.8-6.8) and weight of 15 kg (IQR, 10.6-19.7). Four patients had single MVSD, six had multiple MVSDs. Debanding occurred at a median of 52.8 months (IQR, 18.4-76.6) post-PAB, utilizing six non-compliant Numed Z-MED and four semi-compliant Balt Cristal high-pressure balloons. Median pulmonary valve annulus (PVA) diameters were 15.5 mm (IQR, 12.5-16.8) angiographically. Median balloon-to-PVA diameter ratio was 1 (IQR, 1-1), and median balloon-to-band diameter ratio was 2 (IQR, 1.8-2). Median trans-PAB gradient decreased from 100 mmHg (IQR, 86-108) to 40 mmHg (IQR, 26-46) (p < 0.01) and oxygen saturation improved from a median of 92% (IQR, 86%-97%) to 98% (IQR, 96%-98%) (p < 0.05). There were no procedural complications. Four patients underwent MVSD device closure a median of 7 months (IQR, 3-15) before ED, while seven had concomitant closures, including two with prior closures. Over a median follow-up of 91.7 months (IQR, 71.8-130.7), two patients required redo ED at 23 and 36 months, one with a contained vessel tear. Last recorded maximal Doppler gradient was 27 mmHg (IQR, 9-39).
Conclusions:
Total ED is safe with satisfactory midterm outcomes, though repeat dilations may be necessary during follow-up.
