Midterm Outcomes of Endovascular Pulmonary Artery Debanding in Children.

Background: Pulmonary artery banding (PAB) palliates pulmonary over-circulation, while endovascular debanding (ED) offers a less invasive alternative to repeat surgery.

Objectives: To evaluate our experience with ED.

Aims: Retrospective review of single-center data (2015-2023) on children with single, multiple, or "Swiss-cheese" muscular ventricular septal defects (MVSDs) undergoing ED.

Results: Ten patients (50% male) underwent ED at a median age of 5 years (IQR, 1.8-6.8) and weight of 15 kg (IQR, 10.6-19.7). Four patients had single MVSD, six had multiple MVSDs. Debanding occurred at a median of 52.8 months (IQR, 18.4-76.6) post-PAB, utilizing six non-compliant Numed Z-MED and four semi-compliant Balt Cristal high-pressure balloons. Median pulmonary valve annulus (PVA) diameters were 15.5 mm (IQR, 12.5-16.8) angiographically. Median balloon-to-PVA diameter ratio was 1 (IQR, 1-1), and median balloon-to-band diameter ratio was 2 (IQR, 1.8-2). Median trans-PAB gradient decreased from 100 mmHg (IQR, 86-108) to 40 mmHg (IQR, 26-46) (p < 0.01) and oxygen saturation improved from a median of 92% (IQR, 86%-97%) to 98% (IQR, 96%-98%) (p < 0.05). There were no procedural complications. Four patients underwent MVSD device closure a median of 7 months (IQR, 3-15) before ED, while seven had concomitant closures, including two with prior closures. Over a median follow-up of 91.7 months (IQR, 71.8-130.7), two patients required redo ED at 23 and 36 months, one with a contained vessel tear. Last recorded maximal Doppler gradient was 27 mmHg (IQR, 9-39).

Conclusions: Total ED is safe with satisfactory midterm outcomes, though repeat dilations may be necessary during follow-up.