Pulmonary Artery Reconstruction Following Failed Pulmonary Artery Stents

• Published in: The Annals of thoracic surgery
• Main Authors: Mainwaring, Richard D, Collins, R Thomas, MacMillen, Kirstie L, Palmon, Michal, Hanley, Frank L
• Format: Journal Article
• Language: English
• Published: Netherlands 18-02-2020
• Subjects: Congenital Heart Disease; Pulmonary valve; Pulmonary artery
• ISSN: 1552-6259

Pulmonary artery stents are widely deployed in patients with stenoses ; in the branch pulmonary arteries. However, stents do not address more peripheral sites of ; stenosis and invariably develop in-stent restenosis. The purpose of this study was to review our ; experience with pulmonary artery reconstruction following failed pulmonary artery stents.
This was a retrospective study of 56 patients who underwent pulmonary artery reconstruction following failed pulmonary artery stents. These patients had undergone a median of two previous surgical procedures (range 0-5) and two pulmonary artery stents (range 1-4).
The median age at stent surgery was 5 years (range 0.3 to 23.6 years). The majority of stents (79%) were completely removed and patch augmented. The minority of stents (21%) were felt to be unremovable and thus were split longitudinally and reconstructed using; pulmonary artery homograft. There was one operative mortality (1.8%). The mean pulmonary artery-to-aortic pressure ratio decreased from a pre-operative value of 0.91 ± 0.21 to a post-operative value of 0.31 ± 0.07 (p < 0.001). The median hospital length of stay was 10 days. The median duration of follow-up is 1.8 years. There has been no mid-term mortality. Six patients have undergone balloon dilation post-operatively for residual pulmonary artery stenosis.
Pulmonary artery reconstruction resulted in a significant decrease in pulmonary artery-to-aortic pressure ratios. The subsequent need for re-intervention on the ; pulmonary arteries has been relatively low (11% to date). These results suggest that patients with ; pulmonary artery stents can be successfully treated with surgical reconstruction.