From the Guidelines
Pulmonary artery banding for a Ventricular Septal Defect (VSD) can lead to significant complications, including right ventricular failure, pulmonary artery injury, and respiratory issues, as highlighted in the 2015 American Heart Association and American Thoracic Society guidelines 1. The primary goal of pulmonary artery banding is to protect the pulmonary vascular bed from excessive pressure and flow, but this procedure can also increase the risk of interstage mortality, particularly in patients with correctable biventricular lesions. Some of the potential complications that may arise from this procedure include:
- Right ventricular failure due to increased afterload
- Pulmonary artery injury, such as band migration or erosion
- Respiratory complications, including atelectasis, pneumonia, and prolonged ventilation
- Arrhythmias, particularly right bundle branch block, resulting from right ventricular strain
- Pulmonary valve regurgitation or stenosis, right ventricular hypertrophy, and subaortic stenosis in the long term
- Inadequate band tightness, which can lead to residual VSD or pulmonary hypertension despite banding According to the guidelines, maintaining adequate lung volumes and gas exchange while avoiding acidosis during the postoperative period is crucial for successful outcomes 1. Therefore, close monitoring with echocardiography and potential cardiac catheterization is essential to detect these complications early and prevent long-term cardiac remodeling and dysfunction 1.
From the Research
Complications of Pulmonary Artery Banding for VSD
The following complications might be expected following pulmonary artery banding for a Ventricular Septal Defect (VSD):
- Cardiac complications, such as heart failure and arrhythmia, which were reported in 10% of cases 2
- Pulmonary complications, including pneumothorax and pneumonia, which occurred in 10% of cases 2
- Infectious complications, which were observed in 9% of cases 2
- Death, with a mortality rate of 19% reported in one study, due to causes such as heart failure, arrhythmia, aspiration pneumonia, and poor mixing 2
- Subaortic stenosis, which can occur due to a restrictive ventricular septal defect (VSD), although one study found that pulmonary artery banding was not associated with an increased risk of developing subaortic stenosis 3
Mortality and Morbidity Rates
The mortality and morbidity rates following pulmonary artery banding for VSD are significant, with one study reporting a 30-day mortality rate of 30% for children with VSD 4. Another study reported a late overall mortality rate of approximately 10%, with an attrition rate of 1% per year 4. However, the cumulative mortality for two-stage treatment of VSD was reported to be 8.3% in one study 5.
Long-term Outcomes
The long-term outcomes of pulmonary artery banding for VSD are variable, with some studies reporting good outcomes, such as a significant reduction in pulmonary vascular resistance (PVR) and improved hemodynamics 6. However, other studies have reported complications, such as subaortic stenosis, which can require additional surgical interventions 3.