BackgroundConventional treatment options for end-stage heart failure (ESHF) in children include heart transplantation (HT) and ventricular assist device (VAD), both with significant drawbacks in the pediatric population. Pulmonary artery banding (PAB) strategy embedded in a protective cardiovascular drug regime has been effectively used for functional cardiac regeneration and as a bridge to HT in pediatric ESHF.We herein describe the early and mid-term clinical outcomes from a multicenter international experience. MethodsThis is a multicenter retrospective study including children admitted for ESHF caused by dilated cardiomyopathy of any etiology, who were treated with PAB. The primary outcome was the freedom from death/VAD/HT. Data are summarized as median (interquartile range) and count and percentages. Results31 patients (median age 210 days [131-357]) with ESHF underwent PAB in 5 centers. PEDIMACS score was I-III in 90%; 15 patients were intubated preoperatively. Preoperative left ventricular (LV) ejection fraction was <30% in 68%, with LV dilation in all cases. Postoperatively, median PAB gradient was 29 mmHg (23-34), and complications occurred in 14 patients (45%), with 4 (13%) early deaths. Twenty-seven patients were successfully discharged home on cardiac protective medical therapy. At a median follow-up of 2.9 years, there were 1 late death and 3 HTs. Freedom from death/VAD/HT was 77.3% (95% confidence interval [CI]=58-88.4%), 77.3% (95%CI=58-88.4%), and 73.2% (95%CI=53.2-85.5%) at 6 months, 1 year, and 2 years of follow-up, respectively. All 23 survivors with a native heart had gradual normalization of LV function and dimensions. ConclusionsPAB can be an effective procedure to treat ESHF in selected infants, as an innovative conservative strategy for bridging to transplant or recovery.