The evidence on the efficacy of telemetric adjustable pulmonary artery banding shows that the procedure can provide adjustable reduction of pulmonary artery flow in infants with congenital heart defects, but there are uncertainties about which infants will derive benefit from the procedure. The evidence on safety is limited in quantity. Therefore the procedure should only be used with special arrangements for consent, audit or research and clinical governance.
Clinicians wishing to undertake telemetric adjustable pulmonary artery banding for pulmonary hypertension in infants with congenital heart defects should take the following actions.
Inform the clinical governance leads in their NHS trusts.
Ensure that parents and carers understand the uncertainty about the procedure's safety and efficacy and provide them with clear written information. In addition, the use of NICE's information for the public is recommended.
Enter details about all infants undergoing telemetric adjustable pulmonary artery banding for pulmonary hypertension associated with congenital heart defects onto the UK Central Cardiac Audit Database and review clinical outcomes locally.
Patient selection for telemetric adjustable pulmonary artery banding for pulmonary hypertension in infants with congenital heart defects should only be done in paediatric cardiac centres, by a multidisciplinary team experienced in managing infants and children with congenital heart defects.
Further research should focus on the extended use of telemetric adjustable pulmonary artery banding for ventricular retraining and for its use pending the resolution of ventricular septal defects. Data collection may provide useful information. NICE may review the procedure on publication of further evidence.