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Published on: March 1, 2022
Transcatheter Main Pulmonary Artery Debanding in Children-Immediate and Midterm Outcomes
Hadeel Allam1, Daisuke Kobayashi1, Dominic B Zanaboni1
1Department of Pediatrics, Washington University School of Medicine, Division of Cardiology, St. Louis Children's Hospital, St. Louis, Missouri, USA.
Background:
Surgical main pulmonary artery (PA) banding is a palliative procedure to regulate pulmonary blood flow in patients with ventricular septal defects (VSD)(s).
Aims:
We report on immediate and midterm outcomes of transcatheter PA debanding.
Methods:
Single-center retrospective case series of children who underwent transcatheter debanding between 2017 and 2025. Baseline clinical and follow-up data were reviewed.
Results:
Nine patients underwent transcatheter debanding at a median age of 9 months (Q1-Q3, 7-13) and a median weight of 8.0 kg (7.3-10.3). Surgical PA bands were placed for large or multiple VSDs, with or without aortic coarctation repair. Median time from banding to debanding was 6 months (9-13). Before debanding, right ventricular (RV) systolic pressure was 115% (84-126) of systemic pressure, and the peak right ventricle-to-PA (RV-PA) echocardiographic gradient was 76 mmHg (72-100). Debanding was performed using a balloon-to-angiographic band diameter ratio of 2.3 (2-3.1) and a balloon to angiographic pulmonary valve annulus ratio of 0.93 (0.90-1.02). Post debanding, RV systolic pressure and RV-PA gradient improved to 72% (62-75, p < 0.05) of the systemic pressure and 36 mmHg (30-46; p < 0.05), respectively. Band diameter increased from 4.6 mm (4.5-5.1) to 9.3 mm (8.3-11.0; p < 0.05). There were no major procedural complications. Peak RV-PA gradients remained low at 23 mmHg (12-51) at a median follow-up of 2 years (1-2.4). One patient required repeat balloon angioplasty, and one underwent surgical debanding along with VSD closure.
Conclusion:
Transcatheter PA debanding is safe and effective in selected patients, with sustained low echocardiography gradients in mid-term follow-up.
