Hybrid intra-operative pulmonary artery stenting in congenital heart disease

Objective

Percutaneous branch Pulmonary Artery (PA) stenting can be challenging, especially when associated with stenosis of the Right Ventricular Outflow Tract (RVOT), after previous angioplasty or with complexity of PAs branches. Surgical patch enlargement of Pas alone can be disappointing in these situations. A hybrid-approach, with PA stenting during surgery, may be an alternative to optimize surgical management in complex pulmonary artery stenosis.

Methods

In a 2 year period, 14 consecutive patients with PA stenosis associated with congenital heart disease underwent intraoperative PA stenting. We retrospectively analyzed clinical data, procedural details and outcomes of all patients.

Results

14 patients (1 female), underwent hybrid stenting of the PA. The median age was 6.9 years (range 6 days to 28 years). Primary cardiac diagnoses were pulmonary atresia (n?=?7), tetralogy of Fallot (n?=?5) and other (n?=?2). The left PA was stented in 4 patients, the right in 1 patient and both in 8 patients, for a total of 21 stents. The median maximal balloon diameter was 12 mm (range 6 to 25 mm). Concomitant surgical procedures were RVOT reconstruction with PA patch angioplasty (n?=?8), pulmonary valve replacement (n?=?3) and other (n?=?3). Active suture fixation of the proximal stent was performed in each case. No complications occurred during stent implantation, and no significant cardiac complications occurred perioperatively. The median length of stay in the intensive care unit was 2 days (range 2 to 7 days). The mean follow-up was 9.8 months (range 1 to 19 months). Echocardiography at discharge showed good results in PA branches: the mean peak gradient was 3.8 mmHg (range 0 to 14 mmHg). Most patients showed significant fall in right ventricular systolic pressure after the procedure. No stent needed repeat dilatation.

Conclusion

Hybrid PA stenting during surgery for congenital heart disease in cases of complex branch PA stenosis is an alternative to traditional angioplasty. The procedure is safe and effective, and ameliorates right-ventricular dysfunction.