Endovascular stent implantation for the management of postoperative right ventricular outflow tract obstruction: Clinical efficacy

• Published in: The Journal of thoracic and cardiovascular surgery Vol. 118; no. 5; pp. 886 - 893
• Main Authors: Ovaert, Caroline, Caldarone, Christopher A., McCrindle, Brian W., Nykanen, David, Freedom, Robert M., Coles, J.G., Williams, W.G., Benson, Lee N.
• Format: Journal Article
• Language: English
• Published: Philadelphia, PA Elsevier Inc 01-11-1999; AATS/WTSA; Elsevier
• Subjects: Biological and medical sciences; Cardiac Catheterization; Child; Female; Follow-Up Studies; Heart Defects, Congenital - surgery; Humans; Male; Medical sciences; Palliative Care - methods; Postoperative Complications - surgery; Postoperative Complications - therapy; Prosthesis Implantation; Stents; Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases; Surgery of the heart; Time Factors; Ventricular Outflow Obstruction - etiology; Ventricular Outflow Obstruction - surgery; Ventricular Outflow Obstruction - therapy; Human; Endoprosthesis; Treatment efficiency; Right ventricle; Instrumentation therapy; Exploration; Obstruction; Stent; Pulmonary artery; Treatment; Surgery; Complication; Hemodynamics; Child
• ISSN: 0022-5223; 1097-685X
• DOI: 10.1016/S0022-5223(99)70058-9

Objective: Extracardiac conduits between the right ventricle and pulmonary arteries commit patients to multiple reoperations. We reviewed our experience with stent implantation in obstructed conduits. Methods: Between 1990 and 1997, stents were implanted across 43 conduits. The median age at procedure was 6 years (0.5-17 years), and the median interval between conduit insertion and stent implantation was 2.4 years (0.3-14 years). Results: Mean systolic right ventricular pressures and gradients, respectively, decreased from 71 ± 18 mm Hg and 48 ± 19 mm Hg before to 48 ± 15 mm Hg and 19 ± 13 mm Hg after stent placement. Mean percentage of predicted valve area for body surface area increased from 26% ± 12% to 48% ± 17% after stent placement. Fifteen patients underwent a second transcatheter intervention (dilation or additional stent), and 2 patients, a third, allowing further postponement of surgery in 8 patients. One sudden death occurred 2.8 years after stent placement. Surgical conduit replacement has occurred in 20 patients. Body growth was maintained during follow-up. Freedom from surgical reintervention was 86% at 1 year, 72% at 2 years, and 47% at 4 years. Higher right ventricular pressure and gradient before and after stent placement and lower percentage of predicted valve area for body surface area after stent placement were associated with shorter palliation. Conclusion: Endovascular stent placement across obstructed conduits is a safe and effective palliation that allows for normal body growth. (J Thorac Cardiovasc Surg 1999;118:886-93)