Hybrid Approach for Branch Pulmonary Artery Stenosis in Congenital Heart Disease

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.