Pulmonary artery banding to treat end-stage heart failure in infants and young children: A multicenter study
Massimo A. Padalino, MD, PhD,
Domenico Crea, MD,
Matteo Ponzoni, MD,
Luca Vedovelli, PhD,
Andrzey Kansy, MD,
Thierry Bove, MD,
Joseph Panzer, MD, PhD,
Marc Gewillig, MD,
Bjorn Cools, MD,
Thomas Salaets, MD,
Dexter Cheng, MD,
Andrea Francavilla, MD,
Alessia Cerutti, MD,
Vladimiro Vida, MD, PhD,
Giovanni Di Salvo, MD, PhD,
Biagio Castaldi, MD
Affiliations
Massimo A. Padalino, MD, PhD
Department of Cardiothoracic and Vascular Sciences and Public Health, University of Padova, Padova, Italy; Department of Precision and Regenerative Medicine and Jonian Area, University of Bari, Bari, Italy; Corresponding author: Massimo A. Padalino, MD, PhD, Pediatric and Congenital Cardiac Surgery, Department of Precision and Regenerative Medicine and Jonian Area, University of Bari “Aldo Moro,” Piazza Giulio Cesare, 11, 70124 Bari, Italy.
Domenico Crea, MD
Department of Cardiothoracic and Vascular Sciences and Public Health, University of Padova, Padova, Italy
Matteo Ponzoni, MD
Department of Cardiothoracic and Vascular Sciences and Public Health, University of Padova, Padova, Italy
Luca Vedovelli, PhD
Department of Cardiothoracic and Vascular Sciences and Public Health, University of Padova, Padova, Italy
Andrzey Kansy, MD
Children’s Memorial Health Institute Warsaw, Warsaw, Poland
Thierry Bove, MD
Kliniekhoofd Hartchirurgie, Department of Cardiac Surgery Universitair Ziekenhuis Gent, University Hospital of Ghent, Ghent,Belgium
Joseph Panzer, MD, PhD
Kliniekhoofd Kindercardiologie, Department of Pediatrics Universitair Ziekenhuis Gent, University Hospital of Ghent, Ghent, Belgium
Marc Gewillig, MD
Department of Cardiovascular Sciences, University of Leuven, Leuven, Belgium
Bjorn Cools, MD
Department of Cardiovascular Sciences, University of Leuven, Leuven, Belgium
Thomas Salaets, MD
Department of Cardiovascular Sciences, University of Leuven, Leuven, Belgium
Dexter Cheng, MD
The Medical City Hospital, Manila, Philippines
Andrea Francavilla, MD
Department of Cardiothoracic and Vascular Sciences and Public Health, University of Padova, Padova, Italy
Alessia Cerutti, MD
Department of Woman and Child’s Health, University of Padova, Padova, Italy
Vladimiro Vida, MD, PhD
Department of Cardiothoracic and Vascular Sciences and Public Health, University of Padova, Padova, Italy
Giovanni Di Salvo, MD, PhD
Department of Woman and Child’s Health, University of Padova, Padova, Italy
Biagio Castaldi, MD
Department of Woman and Child’s Health, University of Padova, Padova, Italy
Background: Conventional treatment options for end-stage heart failure (ESHF) in children include heart transplantation (HT) and ventricular assist devices (VADs), both with significant drawbacks in the pediatric population. Pulmonary artery banding (PAB) has been effectively used as bridge to transplant or recovery in pediatric ESHF. We herein describe the early and mid-term clinical outcomes from a multicenter international experience. Methods: This is a multicenter retrospective study including children admitted for ESHF caused by dilated cardiomyopathy and treated with PAB. The primary outcome was the freedom from death/VAD/HT. Results: Thirty-one patients (median age 210 days [131-357]) with ESHF underwent PAB in 5 centers. Pediatric Interagency Registry for Mechanically Assisted Circulatory Support (PEDIMACS) score was I to III in 90%; 15 patients were intubated preoperatively. Preoperative left ventricular (LV) ejection fraction was <30% in 68%, with LV dilation in all cases. Postoperatively, median PAB gradient was 29 mm Hg (23-34), and complications occurred in 14 patients (45%), with 4 (13%) early deaths. Twenty-seven patients were successfully discharged home on anti-congestive therapy. At a median follow-up of 2.9 years, there were 1 late death and 3 HTs. Freedom from death/VAD/HT was 77.3% (95% confidence interval [CI] = 58-88.4%), 77.3% (95%CI=58-88.4%), and 73.2% (95%CI=53.2-85.5%) at 6 months, 1 year, and 2 years of follow-up, respectively. All 23 survivors with a native heart had gradual normalization of LV function and dimensions. Conclusions: PAB can be an effective procedure to treat ESHF in selected infants, as alternative strategy for bridging to transplant or recovery.
