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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.
Insights
Transcatheter pulmonary artery (PA) debanding is a safe and effective procedure for selected patients with ventricular septal defects (VSDs). This minimally invasive approach significantly reduces pulmonary artery pressure and gradients, with sustained benefits at midterm follow-up.
Area of Science:
- Pediatric Cardiology
- Interventional Cardiology
- Congenital Heart Disease Management
Background:
- Surgical pulmonary artery (PA) banding is a palliative treatment for regulating pulmonary blood flow in patients with ventricular septal defects (VSDs).
- Transcatheter PA debanding offers a less invasive alternative for managing these patients.
Purpose of the Study:
- To evaluate the immediate and midterm outcomes of transcatheter PA debanding.
- To assess the safety and efficacy of this minimally invasive procedure.
Main Methods:
- Retrospective case series of children undergoing transcatheter PA debanding (2017-2025).
- Analysis of baseline clinical data and follow-up outcomes.
- Review of procedural parameters including balloon-to-band and balloon-to-annulus ratios.
Main Results:
- Nine patients underwent transcatheter debanding at a median age of 9 months.
- Significant reduction in right ventricular (RV) systolic pressure and RV-PA gradient post-procedure (p < 0.05).
- Sustained low RV-PA gradients (median 23 mmHg) at 2-year follow-up, with no major complications.
Conclusions:
- Transcatheter PA debanding is a safe and effective option for selected pediatric patients.
- The procedure leads to significant hemodynamic improvements with sustained midterm results.
- This approach provides a valuable alternative to surgical debanding.
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.
