A MINIMALLY invasive alternative is reshaping care after pulmonary artery banding, with new findings showing that catheter based debanding can safely relieve pressure overload in infants. Clinicians report immediate haemodynamic improvement and encouraging midterm outcomes without major procedural complications.
Why Pulmonary Artery Banding Is Used
Pulmonary artery banding has long been used as a palliative strategy in infants with large or multiple ventricular septal defects, sometimes alongside repair of aortic coarctation . The surgical band restricts pulmonary blood flow and protects the lungs while children grow strong enough for definitive repair. However, removing or loosening the band has traditionally required repeat surgery, prompting interest in transcatheter techniques that could reduce risk and recovery time after pulmonary artery banding.
Methods and Results: Transcatheter Debanding After Pulmonary Artery Banding
Researchers reported a single centre retrospective case series of children who underwent transcatheter debanding between 2017 and 2025. Nine patients were treated at a median age of 9 months, with a median weight of 8.0 kg. The median time from pulmonary artery banding to debanding was 6 months. Before the procedure, right ventricular systolic pressure measured 115 percent of systemic pressure, and the peak right ventricle to pulmonary artery gradient was 76 mmHg. Debanding used a balloon to angiographic band diameter ratio of 2.3 and a balloon to pulmonary valve annulus ratio of 0.93. After debanding, right ventricular systolic pressure improved to 72 percent of systemic pressure and the gradient fell to 36 mmHg, both with p values below 0.05. Band diameter increased from 4.6 mm to 9.3 mm, again statistically significant. No major procedural complications were reported. At a median follow-up of 2 years, gradients remained low at 23 mmHg. One child required repeat balloon angioplasty, while another proceeded to surgical debanding with ventricular septal defect closure.
Implications for Clinical Practice
These findings suggest that transcatheter debanding can offer a safe and effective option following pulmonary artery banding in carefully selected patients. For paediatric cardiology teams, this approach may reduce the need for repeat open surgery, shorten recovery times, and allow more flexible timing of definitive repair. Further multicentre studies will help refine patient selection and long-term outcomes.
Reference
Allam H et al. Transcatheter main pulmonary artery debanding in children-immediate and midterm outcomes. Catheterization and Cardiovascular Interventions. 2025;DOI:10.1002/ccd.70393.
