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 journalArticlepeer-review

128 Scopus citations

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

Keywords

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

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Physiology (medical)

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