Midterm Outcomes of Endovascular Pulmonary Artery Debanding in Children

ABSTRACT 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.