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Implantation of endovascular stents for the obstructive right ventricular outflow tract
H Sugiyama1, W Williams, L N Benson
1Department of Paediatrics and Surgery, The Hospital for Sick Children, School of Medicine, University of Toronto, Toronto, Ontario, Canada.
Insights
Catheter interventions effectively reduce pressure gradients and improve outflow area in obstructive right ventricle to pulmonary artery conduits. This treatment strategy safely prolongs conduit function in pediatric cardiology patients.
Area of Science:
- Pediatric Cardiology
- Interventional Cardiology
- Congenital Heart Disease
Background:
- Obstructive conduits between the right ventricle and pulmonary arteries often require reintervention.
- Catheter-based interventions offer a less invasive alternative to surgical conduit replacement.
Purpose of the Study:
- To assess the efficacy and long-term outcomes of catheter intervention for obstructive right ventricle-to-pulmonary artery conduits.
- To evaluate the durability and impact of these interventions on patient growth and overall health.
Main Methods:
- Retrospective chart review of 70 procedures in 68 children undergoing catheter intervention for obstructive conduits.
- Analysis included hemodynamic data, outflow area measurements, and rates of subsequent conduit replacement.
Main Results:
- Catheter intervention significantly reduced conduit pressure gradients and increased right ventricular outflow area.
- Freedom from conduit replacement was substantial at 1, 2, and 5 years post-intervention.
- Body growth was maintained, and pulmonary insufficiency was well tolerated, with no reported deaths during follow-up.
Conclusions:
- Catheter intervention is a safe and effective strategy for managing obstructive right ventricle-to-pulmonary artery conduits.
- This approach successfully prolongs the functional life of conduits, potentially delaying or avoiding repeat surgeries.
Objectives:
To evaluate the effectiveness and long term outcomes of catheter intervention for obstructive conduits between the right ventricle and pulmonary arteries.
Design:
Retrospective chart review.
Setting:
Tertiary care paediatric cardiology unit.
Patients And Interventions:
70 procedures in 68 children (median age at intervention 6 years, median interval after conduit insertion 3.4 years) were analysed. All children had haemodynamic indications for conduit replacement. Twenty four children underwent a second intervention (stent dilatation in 17, second stent implantation in seven).
Results:
Mean (SD) conduit pressure gradient decreased from 44 (18) mm Hg to 18 (12) mm Hg at the initial intervention (n = 62, p < 0.001) and from 39 (15) mm Hg to 23 (10) mm Hg at the second intervention (n = 16, p < 0.001). The percentage of the predicted right ventricular outflow area increased from 17 (9)% to 44 (22)% at the initial intervention (n = 62, p < 0.001) and from 24 (8)% to 29 (11)% at the second intervention (n = 21, p < 0.001). The conduit was subsequently replaced in 33 children. Freedom from conduit replacement from the time of stent implantation was 83%, 75%, and 47% at one, two, and five years, respectively, and from the time of the initial conduit surgery it was 87%, 64%, and 42% at five, eight, and 10 years, respectively. Body growth was maintained, no deaths were reported during follow up, and pulmonary insufficiency was well tolerated.
Conclusion:
A catheter treatment strategy for obstructive conduits is safe and effective in prolonging conduit function.
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