"Hybrid" stent delivery in the pulmonary circulation

Area of Science:

• Cardiology
• Interventional Cardiology
• Pediatric Cardiology

Background:

• Pulmonary artery (PA) stenoses are treatable with surgical patch angioplasty, transcatheter stenting, and intraoperative stent delivery.
• Hybrid intraoperative therapy for PA stenoses has gained traction with advancements in techniques and equipment.

Purpose of the Study:

• To describe the institutional experience with hybrid intraoperative stent therapy for pulmonary artery (PA) stenoses.
• To evaluate the safety and effectiveness of this hybrid approach in a pediatric patient cohort.

Main Methods:

• Retrospective review of 20 patients (median age 5.1 years) who underwent hybrid PA stent therapy between March 2003 and April 2008.
• Analysis of stent implantation methods (direct vision, vascular puncture, or combined) and patient outcomes.
• Inclusion of patients with complex congenital heart disease, including tetralogy of Fallot, PA with VSD, and truncus arteriosus.

Main Results:

• Successful stent deployment was achieved in 18/20 (90%) procedures.
• Adverse events occurred in 3/20 (15%) procedures, including two unsuccessful stent deliveries (malposition and fracture).
• Median follow-up was 1.7 years, with 35% of patients requiring re-intervention at the stent site.

Conclusions:

• Hybrid stent delivery in the operating room, via direct vision or vascular puncture, is a safe and effective treatment for PA stenoses.
• A well-equipped hybrid operating suite supports safe intraoperative stent delivery across diverse patient populations.
• Effective collaboration between surgical and interventional teams is crucial for successful outcomes.