Objectives: Branch pulmonary artery (BPA) stenosis is a common finding in patients with congenital
heart disease (CHD), particularly in patients after repair of tetralogy of Fallot
(ToF)/pulmonary atresia (PA). In this subset of patients ~10% require re-intervention
for recurrent BPA stenosis. Valuable treatment modalities for BPA stenosis include
surgical patch angioplasty, percutaneous BPA stenting and hybrid stent placement.
The purpose of this study was to report our institutional experience with hybrid stenting
to treat BPA stenosis.
Methods: Between February 2015 and September 2017, 7 with ToF or PA (3 females) had undergone
elective intraoperative BPA stent placement. All patients had undergone previous surgery.
A total of 8 stents (7 left pulmonary artery, 1 right pulmonary artery) were implanted
under direct vision. Concomitant procedures were RV-PA conduit implantations (n = 5) and VSD closure (n = 1). Retrospective analysis of clinical data, procedural details and outcomes was
performed.
Results: Mean age was 18 ± 13.3 years. Stent implantation was successful in all procedures.
The mean stent diameter was 21 ± 10.1 mm; CP Stents (n = 3), Formula Stents (n = 5) and Cordis Genesis Stents (n = 2) were used. Mean CBP time was 192 ± 106.2 minute and aortic clamping was necessary
in 1 case (VSD closure). Early follow up was complicated in 1 case by a stenosis of
the proximal edge of the LPA stent. Therefore, balloon dilatation was performed (Numed
Tyshak mini 9/2; 4 bar) with good angiographic result. During the remaining follow
up (mean 10 ± 6.3 month) no further catheter re-intervention or surgery was required.
Also, no stent migration, fracture, stent thrombosis or deaths occurred.
Conclusion: Hybrid intraoperative pulmonary artery stenting is safe and effective in selected
patients. It can be used as an alternative for surgical patch angioplasty or if percutaneous
BPA stenting is not feasible in CHD patients with previous cardiac surgery. Short-term
results are encouraging.
