International journal of cardiology · 2025
Pulmonary artery banding as an adjunct to optimized medical therapy in infants and toddlers with severe dilated cardiomyopathy: A strategy to promote cardiac remodeling.
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Panaioli Elena, Pontailler Margaux, Gaudin Regis, Raisky Olivier, Bonnet Damien, Khraiche Diala
Аннотация
BACKGROUND: Dilated cardiomyopathy (DCM) is a leading cause of heart failure in neonates and toddlers. Prophylactic pulmonary artery banding (PAB) has emerged as a potential option to promote functional recovery of the left ventricle in this vulnerable population. This study compared outcomes of PAB plus guideline-directed medical therapy (GDMT) versus GDMT alone in children with severe DCM.
METHODS: We performed a retrospective cohort analysis of 67 patients, 21 treated with PAB and 46 with GDMT alone. Propensity score matching was applied to balance pre-treatment variables including left ventricular (LV) dilation and Ross class. Survival and echocardiographic indices of LV remodeling-changes in LV ejection fraction (LVEF) and LV end-diastolic diameter (LVEDD)-were assessed.
RESULTS: Overall, 15 of 67 patients (22.4%) died, while 52 (777.6%) survived. In the propensity-matched cohort (11 per group), survival was significantly higher in the PAB group (90.9 %) compared to GDMT alone (63.6 %). At 6 months, LVEDD Z-score was markedly lower in the PAB group (1.4 ± 3.0) versus GDMT (6.6 ± 5.1; p = 0.03). By 12 months, LVEF improved to 51.1 ± 8.2% with PAB, compared to 37.8 ± 9.5 % with GDMT (p < 0.05), reflecting superior ventricular recovery.
CONCLUSIONS: PAB may serve as a valuable add-on therapy for infants with severely dilated DCM who do not respond adequately to GDMT.
METHODS: We performed a retrospective cohort analysis of 67 patients, 21 treated with PAB and 46 with GDMT alone. Propensity score matching was applied to balance pre-treatment variables including left ventricular (LV) dilation and Ross class. Survival and echocardiographic indices of LV remodeling-changes in LV ejection fraction (LVEF) and LV end-diastolic diameter (LVEDD)-were assessed.
RESULTS: Overall, 15 of 67 patients (22.4%) died, while 52 (777.6%) survived. In the propensity-matched cohort (11 per group), survival was significantly higher in the PAB group (90.9 %) compared to GDMT alone (63.6 %). At 6 months, LVEDD Z-score was markedly lower in the PAB group (1.4 ± 3.0) versus GDMT (6.6 ± 5.1; p = 0.03). By 12 months, LVEF improved to 51.1 ± 8.2% with PAB, compared to 37.8 ± 9.5 % with GDMT (p < 0.05), reflecting superior ventricular recovery.
CONCLUSIONS: PAB may serve as a valuable add-on therapy for infants with severely dilated DCM who do not respond adequately to GDMT.