Related Experiment Video
Updated: Jun 14, 2025
Use of a Percutaneous Ventricular Assist Device/Left Atrium to Femoral Artery Bypass System for Cardiogenic Shock
Published on: August 16, 2021
Successful Weaning off LVAD Support in an Infant by Pulmonary Artery Banding
Maria Jaros1, Jelena Pabst von Ohain2, Marcus Fischer3
1Kinderkardiologie und Pädiatrische Intensivmedizin, LMU Klinikum Abteilung für Kinderkardiologie und Pädiatrische Intensivmedizin, Munich, Germany.
Insights
Pulmonary artery banding can help wean children off mechanical circulatory support, like left ventricular assist devices (LVADs), by improving left ventricular function. This approach offers a new option for pediatric heart failure management.
Area of Science:
- Pediatric Cardiology
- Cardiovascular Surgery
- Mechanical Circulatory Support
Background:
- Cardiomyopathy is a primary reason for pediatric heart transplantation.
- Mechanical cardiac support is vital for severe pediatric heart failure, aiding recovery or bridging to transplant.
- Pulmonary artery banding is an emerging, debated strategy for failing left ventricles in pediatric heart failure.
Background:
Cardiomyopathy is the leading indication for transplantation in children. Mechanical cardiac support systems play a significant role in treating severe pediatric heart failure for cardiomyoptahy or myocarditis either for recovery or as bridge to transplant. In most cases of chronic heart failure extending over the acute inflammatory phase transplantation is necessary. Organ shortage results in a necessity for further treatment options in terminal heart failure. A new and controversially discussed approach to treat failing (left) ventricles includes pulmonary banding; In some observational studies pulmonary artery banding was performed in patients with severe (left) heart failure and adequate function of the right ventricle. The effect is postulated by improving the contra-lateral (left) ventricular function with intraventricular cross-talk and subsequent myocardial changes. Whereas selected patients may however benefit from PA banding with subsequent training of the left ventricle, nevertheless this strategy is controversially discussed.
Case Description:
A 3-year-old girl with inflammatory myocarditis required left ventricular assist device (LVAD, Berlin Heart)) support. After repetitive weaning failure, pulmonary artery (PA) banding was performed during LVAD support that resulted in an improvement of the left ventricular function and finally LVAD explantation.
Conclusion:
Selected patients may benefit from PA banding with subsequent training of the left ventricle even in the setting of LVAD.This case here is the first reported case where PA banding was successful in the weaning process of a child on mechanical circulatory support (MCS). This principle of pulmonary banding to improve left ventricular function in severe heart failure can apparently also be applied to patients on left ventricular assist devices (LVAD).
