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Published on: October 26, 2016
Stenting and overdilating small Gore-Tex vascular grafts in complex congenital heart disease
Gemma Penford1, Daniel Quandt1, Chetan Mehta1
1Birmingham Children's Hospital, The Heart Unit, West Midlands, United Kingdom.
Insights
Stenting Gore-Tex® grafts in congenital heart disease effectively expands their diameter, improving oxygen saturation and delaying surgery. Adverse events were more common in younger patients with univentricular physiology.
Area of Science:
- Cardiovascular Surgery
- Pediatric Cardiology
- Interventional Cardiology
Background:
- Gore-Tex® grafts are crucial for managing congenital heart disease.
- Graft stenosis or somatic outgrowth can necessitate high-risk early surgery.
- Catheter intervention is an under-reported management option for these graft issues.
Purpose of the Study:
- To evaluate the efficacy and safety of stenting and overdilating small Gore-Tex® vascular grafts.
- To assess the impact of these interventions on optimizing surgical timing.
- To determine outcomes associated with catheter-based graft management.
Main Methods:
- Retrospective analysis of 93 graft stenting interventions in 80 patients over 13 years.
- Interventions aimed at relieving stenosis and/or overdilation.
- Data collected on graft diameter, oxygen saturation, adverse events, and surgical outcomes.
Main Results:
- Graft diameter increased significantly post-intervention (median 102% of nominal size).
- Overdilation achieved a median final internal lumen of 126% of nominal size.
- Mean oxygen saturation improved from 69% to 82%; adverse event rate was 14.9%.
Conclusions:
- Gore-Tex® graft stenting effectively expands lumen diameter beyond nominal size.
- Interventions improve oxygen saturation, facilitate palliation, and optimize surgical timing.
- Adverse events were more frequent in precavopulmonary shunt patients.
Background:
Gore-Tex® grafts are integral in the management of congenital heart disease. Issues of graft stenosis or somatic outgrowth may precipitate high-risk early surgery, and catheter intervention is a relatively under-reported management option.
Objectives:
To assess efficacy, safety, and outcomes of stenting and overdilating small Gore-Tex® vascular grafts with the aim of optimizing surgical timing.
Methods:
Retrospective analysis of single-center, 13-year experience of 93 graft stenting interventions or reintervention in 80 patients, with the aim of relieving stenosis ± overdilation, to depose surgical graft revision or optimize surgical timing and candidacy.
Results:
Median preintervention graft diameter was 52% (IQR 43-63) of nominal size, postintervention this increased to median 102% (IQR 96-120) [P < 0.001]. Overdilation was achieved in 54%; of these, the median final internal lumen was 126% (IQR 113-132) [P < 0.001]. Mean oxygen saturations increased from 69% to 82% [P < 0.001]. Adverse event rate was 14.9%; this includes mortality (3.2%) and atrioventricular conduction block (8.5%). Univariate analysis and logistic regression showed a significant relationship between adverse events and young age [P < 0.01], low weight [P < 0.01], univentricular physiology [P < 0.001], use of femoral venous access alone [P = 0.03], and intervention on a right ventricle to pulmonary artery conduit [P = 0.03]. Within respective indication groups, 74% were bridged to elective cavopulmonary shunt, 95% were bridged to biventricular surgery, and 78% of long-term palliative care patients continue under follow-up.
Conclusions:
Gore-Tex® vascular grafts can be stented effectively and expanded beyond nominal diameters by around +26%. This improves oxygen saturations, providing excellent palliation and optimized surgical timing. Adverse events are most frequent in precavopulmonary shunt patients.
Condensed Abstract:
Gore-Tex® grafts are widely used in the palliation of cyanotic congenital heart disease. Grafts may become stenosed and do not allow for somatic growth. Over a 13 year period, graft stenting was performed in 80 patients (93 technically successful interventions, 4 unsuccessful.) Median internal lumen change was +50% (of nominal graft size), mean oxygen saturation change +13%. Over-dilation was performed in more than half of the cohort, with a median gain of +26% on nominal graft size. In precavopulmonary shunt patients, there was a moderate incidence of serious complications. Clinically useful deferral of surgery was achieved for the majority.
