Two decades of targeted pulmonary artery banding in pediatric dilated cardiomyopathy

Dilated cardiomyopathy (DCM) with severe left ventricular (LV) dysfunction in infants and young children is a life-threatening condition and carries a high risk of mechanical circulatory support and heart transplantation (HTx). Pulmonary artery banding (PAB) has been proposed as a recovery strategy, but data on medium- and long-term outcomes remain limited.

This retrospective, single-center observational study included infants and young children who underwent surgical PAB between 2006 and 2024. Inclusion criteria were ROSS functional class (FC) III/IV, spherical left ventricular-dilated cardiomyopathy (LV-DCM) with left ventricular ejection fraction (LVEF) <35%, and left ventricular end-diastolic diameter (LVEDD) z-score >+4 with preserved right ventricular function. Primary endpoints were overall survival and transplant-free recovery, defined as sustained normalization of LV systolic function with reverse remodeling.

Fifty patients (27 female) met the inclusion criteria and underwent PAB at a median age of 188 days, 70% were in ROSS FC IV, and 42% were listed as urgent for HTx. DCM etiology was idiopathic in 42%, genetic in 22%, and myocarditis-associated in 36%. There was no procedural mortality. Overall survival was 90% and 72% achieved transplant-free functional recovery. Following PAB, magnetic resonance imaging-derived LVEF improved from 19% ± 7% to 56% ± 11%, and LVEDD z-scores decreased from +6.3 to +1 (P < .001). In 33 patients, recovery was sustained over a median follow-up of 7 years, including 15 patients with stable LV function for over 10 years.

In infants and young children with severe LV-DCM, PAB is associated with high long-term survival, sustained transplant-free recovery, and durable reverse cardiac remodeling.