Résultats des cerclages chirurgicaux dans les cardiopathies congénitales biventriculaires et univentriculaires. Série clinique des CUSL
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- Although primary repair is favored in the management of many congenital heart diseases, pulmonary artery banding retains an important role in the management of patients with significant comorbidities or complex cardiac anatomies. This study aims to evaluate the outcomes of pulmonary artery banding in the management of pediatric patients with congenital heart disease associated with unrestricted pulmonary blood flow at the Cliniques universitaires Saint-Luc. In this retrospective, prognosis-oriented study, the medical records of all pediatric patients who underwent pulmonary artery banding between 2008 and 2023 at the Cliniques universitaires Saint-Luc were analyzed. Data were collected between July 2025 and May 2026. Patients with dilated cardiomyopathy, isolated congenitally corrected transposition of the great arteries, and those who received bilateral branch pulmonary artery banding were excluded. Due to fundamental anatomical, pathophysiological, and therapeutic trajectory differences, biventricular and univentricular anomalies were assessed separately without statistical comparison. The primary outcomes were in-hospital mortality and inter-stage mortality. Secondary outcomes included length of hospital stay, the proportion of inter-stage readmission and reintervention, as well as the proportion of reinterventions, the occurrence of complications, and post-repair or post-palliation mortality. Long-term survival after the banding procedure and reintervention-free survival were also estimated. In total, data from 103 patients were analyzed, including 74 (71.8%) patients with a biventricular-type cardiopathy and 29 (28.2%) with a univentricular-type cardiopathy. Banding was performed at a median age of 38 days (4-218) and 20 days (3-1,278) in the biventricular and univentricular groups, respectively. Median weight was 3.6 kg (2.2-6.5) in the biventricular group and 3.0 kg (2.0-12.0) in the univentricular group. Median follow-up duration was 52.4 months (IQR: 16.5-97.4). For patients with biventricular cardiopathy, median hospital stay was 18.5 days (IQR: 12-28). Mortality during the banding hospitalization was 2.7% (2/74). The proportion of inter-stage readmission and reintervention was 41.7% (25/60) and 10.0% (6/60), respectively. Inter-stage mortality was 1.7% (1/60). The proportion of post-repair reintervention was 13.2% (7/53). Overall mortality in this group of patients was 12.2% (9/74). For patients with a univentricular anomaly, median hospital stay was 26 days (IQR: 17-38). In-hospital mortality was 3.4% (1/29). The proportion of inter-stage readmission and reintervention was 24.0% (6/25) and 8.0% (2/25), respectively. No death occurred during the inter-stage period for this group of patients. The proportion of reintervention was 10.5% (2/19). Overall mortality was 17.2% (5/29) in this group. Although some studies report more favorable outcomes with primary repair for certain diagnoses, surgical pulmonary artery banding remains a management strategy to be considered for complex biventricular and univentricular congenital heart diseases or those associated with comorbidities.