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Pulmonary Artery Reinterventions Following Bilateral Pulmonary Artery Banding
Mrinal Patel1, Rittal Mehta1, Aybala Tongut1, Yves d'Udekem1, Can Yerebakan2, Syed Bukhari1, Manan Desai1.
1Children's National Hospital, Washington, DC, USA, 2Nationwide children's Hospital, Columbus, OH, USA.
ObjectiveBilateral pulmonary artery (PA) banding is an initial hybrid palliative strategy to limit pulmonary blood flow in high-risk neonates with complex congenital heart disease. We evaluated PA reinterventions following this approach.
MethodsWe retrospectively reviewed patients who underwent bilateral PA banding between January 2017 and December 2025. Patients who died, underwent transplantation, or were awaiting further surgery were excluded.Among patients proceeding to a second operation-Delayed Norwood (DN), Comprehensive Stage II (CSII), biventricular repair (BVR), or other univentricular palliation (UVP)-PA interventions included Hegar dilatation or patch augmentation. Subsequent surgical (patch augmentation, shunt revision) and catheter-based (balloon or stent angioplasty) PA reinterventions were analyzed.
ResultsSeventy-five patients (median age 3 days, median weight 2.92 kg) underwent PA banding; 33% were premature, 23% had syndromes, and 35% had chromosomal anomalies. Hypoplastic left heart syndrome and its variants accounted for 87% of diagnoses. After excluding 9 patients, 34 (45%) underwent DN, 13 (17%) CSII, 15 (20%) BVR, and 4 (5%) other UVP. Median age at second operation was 58.5 days.PA patch augmentation was performed in 35 patients (53%) during the second operation. Over a median follow-up of 460 days, 39 (59%) required PA reintervention, with a median time of 55 days. Patch augmentation at the second operation was associated with higher odds of subsequent surgical PA reintervention compared to Hegar dilatation (OR 5.34, 95% CI 1.79-15.90, p<0.001).
ConclusionWhile bilateral PA banding is a viable strategy for high-risk neonates, it is associated with frequent PA reinterventions, particularly following patch augmentation.
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