Pulmonary Artery Banding for Functional Regeneration of End-Stage Dilated Cardiomyopathy in Young Children
World Network Report
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We report the worldwide experience of surgical pulmonary artery banding (PAB) treatment of end-stage left ventricular dilated cardiomyopathy (LV-DCM) with preserved right ventricular function. Pediatric LV-DCM is a leading cause of cardiac death,1,2 especially if the left ventricular end-diastolic diameter exceeds a z score of +5.3 Heart transplantation (HTx) is the only viable life-saving option, but is limited by donor availability and an unpredictable long-term survival. PAB was introduced on the following hypotheses4: (1) geometric rearrangement of LV dimension is achieved by reestablishing the interventricular septal position with gradual restoration of LV ejection fraction; (2) cardiac improvement with potential for regeneration reciprocal to the patient’s age5 is promoted by PAB-induced right ventricular hypertrophy. Fifteen centers of 11 countries from America, Asia, and Europe introduced PAB in an effort to diminish the need for LV assist device support and HTx, and especially to enable functional recovery.
The Figure shows the flowchart of 70 patients who received PAB between March 2006 and 2017. Nine patients (mean age 159±101days) underwent PAB placement after complex open-chest procedures including: mitral valve repair (n=4); mitral valve replacement (n=1), anomalous left coronary artery arising from the pulmonary artery repair (n=1), epicardial pacemaker placement (n=1), fenestrated atrial septal defect closure (n=1), and repair of a left-sided partial anomalous pulmonary venous return (n=1). All but the latter patient recovered following a mean …