[I-AEPCJS-2] Japanese experience of pulmonary arterial banding for pediatric heart failure
Keywords:Heart Failure, Pulmonary arterial banding, Mechanical circulatory support
Although medical therapy for heart failure have been improved with so called fantastic four in adult field in the past decade, most of these new medications are unavailable for small children. Thus, when pediatric patient is in severe heart failure regardless of beta blocker therapy and inotropes, mechanical circulatory support and heart transplantation (HTx) are indicated. However, implantable ventricular assist device (VAD) is only available in patient weighting more than 15 kg at least, and non-implantable VAD require hospitalization for entire time waiting for transplant. Unfortunately, waiting time for HTx in Japan is as long as 3 years in pediatric patients, and more than 5 years in adult patients. And the number of EXCOR, the only non-implantable VAD for long term use, is limited in Japan. Therefore, it is very important to investigate other strategy to avoid or delay VAD or HTx in small children.
Pulmonary arterial banding, one of the oldest surgical interventions for congenital heart disease, have been utilized to improve cardiac function for those with preserved right ventricular function and younger than 4 years old. According to the German group, one third of the patients showed improvement of the left ventricular function. As far as I know, there are only three cases in Japan. In our hospital, we tried 2 cases, and one could delay the VAD implantation for about a year, and was successfully transplanted after one year of EXCOR support.
We would like to discuss about indication of PAB for heart failure, timing, indication of ballon dilation for tight band after growth, and if PAB could be one of the strategies we should consider to avoid HTx in our country.
Pulmonary arterial banding, one of the oldest surgical interventions for congenital heart disease, have been utilized to improve cardiac function for those with preserved right ventricular function and younger than 4 years old. According to the German group, one third of the patients showed improvement of the left ventricular function. As far as I know, there are only three cases in Japan. In our hospital, we tried 2 cases, and one could delay the VAD implantation for about a year, and was successfully transplanted after one year of EXCOR support.
We would like to discuss about indication of PAB for heart failure, timing, indication of ballon dilation for tight band after growth, and if PAB could be one of the strategies we should consider to avoid HTx in our country.