Hybrid intraoperative pulmonary artery stent placement for congenital heart disease

Objectives: Percutaneous branch pulmonary artery (PA) stenting can be challenging, especially in patients with stenosis of the right ventricular (RV) outflow tract or tortuous PA branches. In these cases, a hybrid procedure deploying PA stent(s) during cardiac surgery provides an alternative to relieve branch PA stenosis. The congenital Cardiac surgical database of the university hospital of Cologne and Zurich was used to identify all patients having hybrid PA stent procedures. Retrospective analysis of clinical data, procedural details, and outcomes was performed.

Methods: Between January 2005 and January 2009, 42 patients, median age 6 years (range 1 to 13), had hybrid stent procedures. A total of 50 stents were deployed. A left PA stent was placed in 22, right PA in 12, and 8 patients had bilateral stents. Primary cardiac diagnoses were pulmonary atresia (19), tetralogy of Fallot (14), tricuspid atresia (4), and others (5). Balloon diameter ranged from 8 to 14 (median=10mm). Concomitant surgical procedures were RV to PA conduit replacement or RV outflow tract reconstruction (21), pulmonary valve replacement (11) and others (10). Four procedures were performed following complications of percutaneous procedure.

Results: There were no death or PA damage. There were 2 cases of distal stent migration. Repeat stent dilations within 6 months were performed in 5 patients.

Conclusion: Hybrid PA stenting is important in the management of congenital heart disease with complex PA anatomy. It also can be used as an emergency rescue procedure following complications of percutaneous transcatheter procedures, such as stent embolization.