Longterm outcome after branch pulmonary artery stenosis stenting in congenital heart diseases

Abstract

IntroductionPrimary or secondary branch pulmonary artery (BPA) stenosis complicates the management of congenital heart diseases. Surgical pulmonary plasty is the gold standard treatment, but is associated with a low freedom from reintervention rate of 46% at 10 years [1]. As an alternative, percutaneous or intraoperative stents have been implanted to improve efficiency, but limited data are available concerning longterm outcome [2–5]. We hypothesized that prognosis of intraoperative or percutaneous stent implantation in BPA stenosis is good with further re-expansion and limited complications. MethodsWe conducted a retrospective cohort study at CHU de Tours. All stents implanted by surgery or catheterization in BPA with a minimum follow-up of 12 months and at least 1 catheterization control have been included. The primary endpoint was composite, combining cardiovascular mortality, surgical stent removing or percutaneous implantation of a new homolateral stent. ResultsBetween February 2007 and December 2017, 76 stents in 51 patients were included (62 stents implanted by surgery, 14 by catheterization). At the time of implantation, patients had mean age and weight of 56.3 months (IQR 65.4) and 17.4 kgs (IQR 11.0) respectively. There was 68.4% of secondary stenosis. Mean BPA minimum size was 4.1mm (mean Z-score of−5.0), and mean initial stent diameter was 9.1mm. During a mean follow-up of 5.3 years (range 0–11,2 years), freedom from primary endpoint was 86.8% (CI 79.6–94.8%) at 1 year, 78.9% (CI 70.2–88.6%) at 2 years, 71.5% (CI 61.9–82.7%) at 5 years and 69.6% (CI 59.6–81.2%) at 10 years (Fig. 1). Among surviving stents, mean BPA size Z-score at last evaluation was increase of +4.69 compared to initial size (P<0.001) (Fig. 2). A lower BPA size at implantation seemed to be associated with a worse outcome of the stent (P<0.05). ConclusionOur results suggest that percutaneous or intraoperative stent implantation could constitute a good alternative to BPA plasty alone.