Pulmonary artery banding for cardiomyopathy in young children: First trial in China

Abstract

Aims: Heritable dilated cardiomyopathy (DCM) or DCM associated with congenital or acquired left ventricular diseases carries a significant mortality risk. Pulmonary artery banding (PAB) has been proposed as an alternative to heart transplantation. This study aimed to delineate the clinical development, ventricular reverse remodelling, and functional regeneration of the dilated left ventricle, presenting as a pioneering approach in China.

Methods and results: This prospective study was initiated in November 2021, involving paediatric patients with a significant dilated left ventricle and preserved right ventricle who underwent surgical PAB. The baseline characteristics and clinical information during follow-up were collected. Seven patients (five boys) with a median age of 240 (148, 1028) days have been included thus far. No procedural or follow-up mortality was observed. The modified Ross functional class improved from treatment to follow-up of 348 (200, 629) days, and the median left ventricular ejection fraction increased from 27.0 (15.0, 34.0) % before surgery to 61.0 (52.0, 68.0) % (P < 0.05); the median left ventricular end-diastolic diameter and corresponding Z-scores decreased from 43.0 (40.0, 55.0) mm [+9.4 (+7.7, +11.7)] to 33.0 (29.0, 39.0) mm [+1.8 (+1.3, +3.8)] (P < 0.05). Functional regeneration of the left ventricle was observed in five patients. Three of them underwent balloon dilation of the PAB to relieve excessively elevated right ventricular pressures.

Conclusions: The application of PAB should adhere to strict criteria. Initial results are promising for infants and even toddlers with a dilated left ventricle and limited probability of spontaneous recovery. PAB can be an alternative when there is a shortage of donor transplants and assist devices, especially for low- and middle-income countries.

Keywords: Cardiac regeneration; Dilated cardiomyopathy; Paediatric heart failure; Pulmonary artery banding.

Figure 1

Pulmonary artery banding was placed through a relatively small pericardial incision.

Figure 2

Comparison of the patients' preoperative, discharge, and follow‐up conditions. (A) Line graph of the change in LVEF for each patient. (B) Box plot of the change in LVEF. (C) Line graph of the change in LVEDD Z‐scores for each patient. (D) Box plot of the change in LVEDD Z‐scores. LVEDD, left ventricular end‐diastolic diameter; LVEF, left ventricular ejection fraction.