Transcatheter Main Pulmonary Artery Debanding in Children-Immediate and Midterm Outcomes.

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.