Pulmonary artery banding in pediatric dilated cardiomyopathy: A systematic review and meta-analysis of clinical outcomes and ventricular remodeling.

Objective: Pulmonary artery banding has reemerged as a potential therapeutic strategy for pediatric dilated cardiomyopathy, aiming to promote left ventricular recovery and serve as an alternative or bridge to advanced therapies. However, comprehensive data on its efficacy and safety remain limited. Methods: We conducted a systematic review and meta-analysis of studies enrolling pediatric patients (<18 years) with dilated cardiomyopathy undergoing pulmonary artery banding. Primary outcomes included changes in left ventricular ejection fraction and left ventricular end-diastolic diameter z-score. Clinical outcomes included native heart survival, all-cause mortality, need for mechanical support, heart transplantation, and pulmonary artery banding failure (death, ventricular assist device, or heart transplantation). Random-effects models were used to pool estimates, and study quality was assessed with Risk Of Bias In Non-randomized Studies of Interventions and Grading of Recommendations, Assessment, Development and Evaluations. Results: Ten studies comprising 175 patients were included. Pulmonary artery banding was associated with a mean increase in left ventricular ejection fraction of +35.3% (95% CI, 32.2-38.6) and a mean reduction in left ventricular end-diastolic diameter z-score of -6.5 (95% CI, -7.6 to -5.5). At latest follow-up, native heart survival was 81.5% (95% CI, 62.1-92.2), all-cause mortality was 10.9% (95% CI, 7.0-16.4), heart transplantation was 6.5% (95% CI, 1.3-26.7), mechanical support was 10.1% (95% CI, 4.0-23.1), and pulmonary artery banding failure was 18.5% (95% CI, 7.8-38.0). Complications included low cardiac output syndrome (45%) and reintervention (up to 43%). Conclusions: In pediatric dilated cardiomyopathy, pulmonary artery banding was associated with significant reverse remodeling and favorable native heart survival. These findings suggest pulmonary artery banding may be a promising strategy to delay or avoid ventricular assist device or heart transplantation in selected children, offering the unique possibility of recovery. Nonetheless, perioperative risks and uncertain long-term durability underscore that pulmonary artery banding should be considered a selective rather than universal intervention, with prospective multicenter studies required to confirm its role within the therapeutic spectrum of pediatric dilated cardiomyopathy. Future research should focus on optimizing patient selection and procedural timing.