Risk Factors of Prolonged Mechanical Ventilation Following Pulmonary Artery Banding in Children With Single Ventricle Physiology

Abstract

Introduction: Prolonged mechanical ventilation (PMV) is a postoperative burden in single ventricle physiology (SVP) pediatric patients undergoing pulmonary artery (PA) banding. Predicting the optimal band tightness and its postoperative impact remains challenging, particularly in low- and middle-income countries, as evidence linking risk factors to PMV following PA banding is still limited. This study aimed to identify perioperative risk factors associated with PMV following PA banding in pediatric patients with SVP. Methods: This retrospective, single-center cohort study included 101 children with SVP who underwent PA banding between 2017 and 2023. Binomial logistic regression models were used to examine the association of perioperative risk factors and PMV (>126 h). Secondary outcomes included in-hospital mortality, postoperative complications, and PA rebanding. A P-value of  < .05 was considered statistically significant. Results: Prolonged MV occurred in 31.7% (32/101) of patients. A higher peak right ventricle-pulmonary artery (RV-PA) pressure gradient was associated with lower odds of postoperative prolonged MV (OR = 0.894, P = .018). Significantly lower PMV risk was associated with RV-PA gradient values above the cut-off value of 39.5 mm Hg (AUC 0.665, 95% CI 0.538−0.792, P = .012, Youden index 0.387). Nevertheless, abnormally low postoperative mean arterial pressure (MAP) was independently associated with PMV (P = .038). Conclusions: Peak RV-PA gradient > 39.5 mm Hg and stable postbanding MAP help reduce PMV risk in children with SVP undergoing PA banding. Incorporating bodyweight and oxygenation status in prebanding assessment may reduce risk of postoperative mortality. These findings offer guidance for integrated perioperative assessment, particularly in resources-limited centers.