Hemodynamic and Anesthesia Management in Pediatric Pulmonary Artery Banding for Dilated Cardiomyopathy: A 20-Year Retrospective Cohort Study

Objective To describe anesthesiologic protocols and outcomes in pediatric dilated cardiomyopathy (DCM) patients undergoing isolated pulmonary artery banding (PAB) Design Retrospective cohort study. Setting Single tertiary care center using PDMS for comprehensive perioperative data collection between April 2006 and February 2026. Participants 60 infants/children with DCM undergoing isolated PAB had a mean age of 10.4 months (95% CI: 7.7–13.2) and mean weight of 7.3 kg (95% CI: 6.6–8.0), and 53% were male. Preoperative LVEF was 22% (95% CI: 20–25%); RVEF was preserved at 57% (95% CI: 55–60%). 85% required inotropic support, and 17% were mechanically ventilated. Intervention PAB included perioperative management with continuous inotropic/vasoactive support to maintain systemic perfusion and hemodynamic monitoring using transesophageal echocardiography, cerebral near-infrared spectroscopy, and right ventricular pressure measurement. Measurements and Main Results Primary outcomes: hemodynamic parameters (RV systolic pressure (sRVP), sRVP/systolic arterial pressure (sAP) ratio), pharmacologic support, ventilation duration, ICU stay, and survival. Intraoperatively, sRVP was titrated to a mean of 51 mmHg (95% CI: 48–53), achieving a sRVP/sAP ratio of 0.68 (95% CI: 0.65–0.72; median 0.7). Post-PAB, 100% required inotropic/vasoactive support. Significant changes: ↑ heart rate (131→149 bpm), ↓ mean arterial pressure (58→53 mmHg), ↓ SvO₂ (76%→68%), ↓ ScerebO₂ (79%→72%) (all p <0.05). Mean ventilation duration: 95 hours (95% CI: 61–130); ICU stay: 14 days (5% trimmed mean). Estimated overall survival: 16 years (95% CI: 14–18); HTx rate: 23%; mortality: 8%. Conclusions PAB in pediatric DCM requires specialized perioperative management with universal inotropic support. The sRVP/sAP ratio of ∼0.7 confirms effective RV pressure titration. While outcomes are promising with an estimated 16-year survival, care remains resource-intensive. Limitations include the retrospective, single-center design.