0176: Intraoperative pulmonary artery stenting for management of pulmonary artery stenosis in children with congenital heart diseases: a single center 5-year experience

Abstract

Patients with Congenital Heart Diseases (CHD) often suffer from severe pulmonary artery (PA) stenosis. Management of PA stenosis is challenging for surgeons. The purpose of this study was to assess the results of intraoperative pulmonary artery stenting, performed additionally to, or instead of, conventional surgical angioplasty. Between January 2008 and August 2013, 31 children with hypoplastic or stenosed PA, median age of 23 months (range 6 days to 15 years), and median weight of 11,8kg (range 2,8 to 63kg), underwent intraoperative placement of stents in PA. Patients had pulmonary atresia (15) tetralogy of Fallot (10) troncus arteriosus (4), and complex CHD (2). The aim of the concomitant surgical procedure was palliative surgery (10), complete repair (12), or improvement of right ventricular outflow tract after complete repair (9). A total of 42 balloon-expandable stents were deployed in left or right PA. Maximum balloon diameters ranged from 3 to 16mm (mean=9). Post-operative mortality was 9,6% (3 patients) and 2 patients did not have complete follow-up. Eighteen patients underwent angiographic control, at a mean follow-up of 15 months (± SD 10 months) after surgery. Mean PA diameter increased from 5,19 to 7,57mm (p<0,001). Eight patients did not have angiography to date because routine echocardiography follow-up showed patent pulmonary arteries, with low residual gradient. Two patients (7,6%) needed a reoperation for severe intra-stent stenosis. Nine patients (34,6%) had repeated dilatation, performed percutaneously or during further intervention to complete repair of their CHD. Intraoperative stenting of PA is an effective option to prevent recoil and external compression. However, smaller stents seem to be at higher risk of intra-stent proliferation.