Contemporary Applications and Outcomes of Pulmonary Artery Banding: An Analysis of the STS CHSD

BACKGROUND Pulmonary artery banding (PAB) in isolation or combined with a congenital cardiac surgical procedure is common and has important mortality. We aimed to determine patient characteristics, clinical outcomes, variation in clinical outcomes by diagnoses, and center variation in PAB use. METHODS Using the Society of Thoracic Surgeons Congenital Heart Surgery Database (STS CHSD), this study evaluated outcomes of patients undergoing PAB across diagnoses, participating centers, and additional procedures. Patients were identified using procedure/diagnosis codes from 2016-2019. We separated main and bilateral PAB patient groups and described their outcomes, focusing on main PAB patients. RESULTS This study identified 3,367 PAB procedures from 2016-2019 (3% of all STS CHSD cardiovascular cases during this period): 2,677 main PAB, 690 bilateral PAB. Operative mortality was 8% after main PAB and 26% after bilateral PAB. There was significant variation in use of main PAB by center with 115 centers performing at least 1 main PAB procedure (range: 1-134, Q1-Q3: 8-33). Among main PAB patients, there were substantial differences in mortality depending on timing of main PAB relative to other procedures. The highest operative mortality, 25%, p<0.0001, was in patients who underwent main PAB following another separate procedure during their admission, with extracorporeal membrane oxygenation (ECMO) being the most frequent preceding procedure. CONCLUSIONS PAB is a frequently used congenital cardiac procedure with high mortality and variation in use across centers. Outcomes vary widely by banding type and patient diagnosis. Main PAB after cardiac surgical procedures, especially ECMO, is associated with very high operative mortality.