Endovascular stenting of obstructed right ventricle-to-pulmonary artery conduits: A 15-year experience

Lynn F. Peng, Doff B. McElhinney, Alan W. Nugent, Andrew J. Powell, Audrey C. Marshall, Emile A. Bacha, James E. Lock

Research output: Contribution to journalArticle

126 Citations (Scopus)

Abstract

BACKGROUND - The optimal treatment for dysfunctional right ventricle-to-pulmonary artery (RV-PA) conduits is unknown. Limited follow-up data on stenting of RV-PA conduits have been reported. METHODS AND RESULTS - Between 1990 and 2004, deployment of balloon-expandable bare stents was attempted in 242 obstructed RV-PA conduits in 221 patients (median age, 6.7 years). Acute hemodynamic changes after stenting included significantly decreased RV systolic pressure (89±18 to 65±20 mm Hg, P<0.001) and peak RV-PA gradient (59±19 to 27±14 mm Hg, P<0.001). There were no deaths, and, aside from 5 malpositioned stents requiring surgical removal, there were no serious procedural complications. During follow-up of 4.0±3.2 years, 9 patients died and 2 underwent heart transplantation, none related to catheterization or stent malfunction. During 155 follow-up catheterizations in 126 patients, the stent was redilated in 83 patients and additional stents were placed in 41. Stent fractures were diagnosed in 56 patients (43%) and associated with stent compression and substernal location but did not cause acute hemodynamic consequences. By Kaplan-Meier analysis, median freedom from conduit surgery after stenting was 2.7 years (3.9 years in patients >5 years), with younger age, homograft conduit, conduit diameter ≤10 mm, diagnosis other than tetralogy of Fallot, Genesis stent, higher prestent RV:aortic pressure ratio, and stent malposition associated with shorter freedom from surgery. Tricuspid regurgitation and RV function did not change between stent implantation and subsequent surgery. CONCLUSIONS - Conduit stenting is an effective interim treatment for RV-PA conduit obstruction and prolongs conduit lifespan in most patients. Stent fractures were common but not associated with significant complications or earlier conduit reoperation.

Original languageEnglish (US)
Pages (from-to)2598-2605
Number of pages8
JournalCirculation
Volume113
Issue number22
DOIs
StatePublished - Jun 2006

Fingerprint

Pulmonary Artery
Heart Ventricles
Stents
Tricuspid Valve Insufficiency
Tetralogy of Fallot
Reoperation
Allografts
Arterial Pressure
Hemodynamics
Blood Pressure
Therapeutics

Keywords

  • Double-outlet right ventricle
  • Pulmonary valve
  • Tetralogy of Fallot
  • Transposition of the great arteries
  • Truncus arteriosis

ASJC Scopus subject areas

  • Physiology
  • Cardiology and Cardiovascular Medicine

Cite this

Peng, L. F., McElhinney, D. B., Nugent, A. W., Powell, A. J., Marshall, A. C., Bacha, E. A., & Lock, J. E. (2006). Endovascular stenting of obstructed right ventricle-to-pulmonary artery conduits: A 15-year experience. Circulation, 113(22), 2598-2605. https://doi.org/10.1161/CIRCULATIONAHA.105.607127

Endovascular stenting of obstructed right ventricle-to-pulmonary artery conduits : A 15-year experience. / Peng, Lynn F.; McElhinney, Doff B.; Nugent, Alan W.; Powell, Andrew J.; Marshall, Audrey C.; Bacha, Emile A.; Lock, James E.

In: Circulation, Vol. 113, No. 22, 06.2006, p. 2598-2605.

Research output: Contribution to journalArticle

Peng, LF, McElhinney, DB, Nugent, AW, Powell, AJ, Marshall, AC, Bacha, EA & Lock, JE 2006, 'Endovascular stenting of obstructed right ventricle-to-pulmonary artery conduits: A 15-year experience', Circulation, vol. 113, no. 22, pp. 2598-2605. https://doi.org/10.1161/CIRCULATIONAHA.105.607127
Peng, Lynn F. ; McElhinney, Doff B. ; Nugent, Alan W. ; Powell, Andrew J. ; Marshall, Audrey C. ; Bacha, Emile A. ; Lock, James E. / Endovascular stenting of obstructed right ventricle-to-pulmonary artery conduits : A 15-year experience. In: Circulation. 2006 ; Vol. 113, No. 22. pp. 2598-2605.
@article{2c1e79b7e32741429e8392e463ff4f89,
title = "Endovascular stenting of obstructed right ventricle-to-pulmonary artery conduits: A 15-year experience",
abstract = "BACKGROUND - The optimal treatment for dysfunctional right ventricle-to-pulmonary artery (RV-PA) conduits is unknown. Limited follow-up data on stenting of RV-PA conduits have been reported. METHODS AND RESULTS - Between 1990 and 2004, deployment of balloon-expandable bare stents was attempted in 242 obstructed RV-PA conduits in 221 patients (median age, 6.7 years). Acute hemodynamic changes after stenting included significantly decreased RV systolic pressure (89±18 to 65±20 mm Hg, P<0.001) and peak RV-PA gradient (59±19 to 27±14 mm Hg, P<0.001). There were no deaths, and, aside from 5 malpositioned stents requiring surgical removal, there were no serious procedural complications. During follow-up of 4.0±3.2 years, 9 patients died and 2 underwent heart transplantation, none related to catheterization or stent malfunction. During 155 follow-up catheterizations in 126 patients, the stent was redilated in 83 patients and additional stents were placed in 41. Stent fractures were diagnosed in 56 patients (43{\%}) and associated with stent compression and substernal location but did not cause acute hemodynamic consequences. By Kaplan-Meier analysis, median freedom from conduit surgery after stenting was 2.7 years (3.9 years in patients >5 years), with younger age, homograft conduit, conduit diameter ≤10 mm, diagnosis other than tetralogy of Fallot, Genesis stent, higher prestent RV:aortic pressure ratio, and stent malposition associated with shorter freedom from surgery. Tricuspid regurgitation and RV function did not change between stent implantation and subsequent surgery. CONCLUSIONS - Conduit stenting is an effective interim treatment for RV-PA conduit obstruction and prolongs conduit lifespan in most patients. Stent fractures were common but not associated with significant complications or earlier conduit reoperation.",
keywords = "Double-outlet right ventricle, Pulmonary valve, Tetralogy of Fallot, Transposition of the great arteries, Truncus arteriosis",
author = "Peng, {Lynn F.} and McElhinney, {Doff B.} and Nugent, {Alan W.} and Powell, {Andrew J.} and Marshall, {Audrey C.} and Bacha, {Emile A.} and Lock, {James E.}",
year = "2006",
month = "6",
doi = "10.1161/CIRCULATIONAHA.105.607127",
language = "English (US)",
volume = "113",
pages = "2598--2605",
journal = "Circulation",
issn = "0009-7322",
publisher = "Lippincott Williams and Wilkins",
number = "22",

}

TY - JOUR

T1 - Endovascular stenting of obstructed right ventricle-to-pulmonary artery conduits

T2 - A 15-year experience

AU - Peng, Lynn F.

AU - McElhinney, Doff B.

AU - Nugent, Alan W.

AU - Powell, Andrew J.

AU - Marshall, Audrey C.

AU - Bacha, Emile A.

AU - Lock, James E.

PY - 2006/6

Y1 - 2006/6

N2 - BACKGROUND - The optimal treatment for dysfunctional right ventricle-to-pulmonary artery (RV-PA) conduits is unknown. Limited follow-up data on stenting of RV-PA conduits have been reported. METHODS AND RESULTS - Between 1990 and 2004, deployment of balloon-expandable bare stents was attempted in 242 obstructed RV-PA conduits in 221 patients (median age, 6.7 years). Acute hemodynamic changes after stenting included significantly decreased RV systolic pressure (89±18 to 65±20 mm Hg, P<0.001) and peak RV-PA gradient (59±19 to 27±14 mm Hg, P<0.001). There were no deaths, and, aside from 5 malpositioned stents requiring surgical removal, there were no serious procedural complications. During follow-up of 4.0±3.2 years, 9 patients died and 2 underwent heart transplantation, none related to catheterization or stent malfunction. During 155 follow-up catheterizations in 126 patients, the stent was redilated in 83 patients and additional stents were placed in 41. Stent fractures were diagnosed in 56 patients (43%) and associated with stent compression and substernal location but did not cause acute hemodynamic consequences. By Kaplan-Meier analysis, median freedom from conduit surgery after stenting was 2.7 years (3.9 years in patients >5 years), with younger age, homograft conduit, conduit diameter ≤10 mm, diagnosis other than tetralogy of Fallot, Genesis stent, higher prestent RV:aortic pressure ratio, and stent malposition associated with shorter freedom from surgery. Tricuspid regurgitation and RV function did not change between stent implantation and subsequent surgery. CONCLUSIONS - Conduit stenting is an effective interim treatment for RV-PA conduit obstruction and prolongs conduit lifespan in most patients. Stent fractures were common but not associated with significant complications or earlier conduit reoperation.

AB - BACKGROUND - The optimal treatment for dysfunctional right ventricle-to-pulmonary artery (RV-PA) conduits is unknown. Limited follow-up data on stenting of RV-PA conduits have been reported. METHODS AND RESULTS - Between 1990 and 2004, deployment of balloon-expandable bare stents was attempted in 242 obstructed RV-PA conduits in 221 patients (median age, 6.7 years). Acute hemodynamic changes after stenting included significantly decreased RV systolic pressure (89±18 to 65±20 mm Hg, P<0.001) and peak RV-PA gradient (59±19 to 27±14 mm Hg, P<0.001). There were no deaths, and, aside from 5 malpositioned stents requiring surgical removal, there were no serious procedural complications. During follow-up of 4.0±3.2 years, 9 patients died and 2 underwent heart transplantation, none related to catheterization or stent malfunction. During 155 follow-up catheterizations in 126 patients, the stent was redilated in 83 patients and additional stents were placed in 41. Stent fractures were diagnosed in 56 patients (43%) and associated with stent compression and substernal location but did not cause acute hemodynamic consequences. By Kaplan-Meier analysis, median freedom from conduit surgery after stenting was 2.7 years (3.9 years in patients >5 years), with younger age, homograft conduit, conduit diameter ≤10 mm, diagnosis other than tetralogy of Fallot, Genesis stent, higher prestent RV:aortic pressure ratio, and stent malposition associated with shorter freedom from surgery. Tricuspid regurgitation and RV function did not change between stent implantation and subsequent surgery. CONCLUSIONS - Conduit stenting is an effective interim treatment for RV-PA conduit obstruction and prolongs conduit lifespan in most patients. Stent fractures were common but not associated with significant complications or earlier conduit reoperation.

KW - Double-outlet right ventricle

KW - Pulmonary valve

KW - Tetralogy of Fallot

KW - Transposition of the great arteries

KW - Truncus arteriosis

UR - http://www.scopus.com/inward/record.url?scp=33745168297&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=33745168297&partnerID=8YFLogxK

U2 - 10.1161/CIRCULATIONAHA.105.607127

DO - 10.1161/CIRCULATIONAHA.105.607127

M3 - Article

C2 - 16735676

AN - SCOPUS:33745168297

VL - 113

SP - 2598

EP - 2605

JO - Circulation

JF - Circulation

SN - 0009-7322

IS - 22

ER -