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Premounted stents for branch pulmonary artery stenosis in children: A short term solution

Yinn Khurn Ooi1,2, Sung In H Kim3, Scott E Gillespie2

  • 1Division of Cardiology, Children's Healthcare of Atlanta, Atlanta, Georgia.

Catheterization and Cardiovascular Interventions : Official Journal of the Society for Cardiac Angiography & Interventions
|September 10, 2018
PubMed

Insights

Premounted stent implantation (PMS) effectively treats pediatric branch pulmonary artery stenosis (BPAS) in the short term. However, long-term outcomes show a high need for surgical stent intervention and repeat procedures.

Area of Science:

  • Pediatric cardiology
  • Interventional cardiology
  • Congenital heart disease

Background:

  • Branch pulmonary artery stenosis (BPAS) in children presents challenges for long-term stent viability and expansion.
  • Premounted stent implantation (PMS) is a potential treatment, but its long-term efficacy requires evaluation.

Purpose of the Study:

  • To define the outcomes of premounted stent implantation (PMS) for treating branch pulmonary artery stenosis (BPAS) in pediatric patients.
  • To assess the need for surgical stent intervention (SSI) and repeat interventions (RI) after PMS for BPAS.

Main Methods:

  • A retrospective review of cardiac database records from an 11-year period (ending 2013) was conducted.
  • Data from 82 PMS implantations in 60 children with BPAS were analyzed.
  • Primary endpoint was the need for surgical stent intervention (SSI); secondary endpoints included acute results and repeat interventions (RI).

Main Results:

  • PMS acutely improved vessel diameter (2.0 to 5.0 mm) and decreased pressure gradients (41 to 11 mmHg) and RV:Ao pressure ratio (100% to 59%) (p < 0.001).
  • Freedom from SSI was 81% at 1 year and 35% at 5 years; freedom from RI was 50% at 1 year and 14% at 5 years.
  • 86% of PMS required SSI during concomitant cardiac surgery, and 45% underwent redilation, increasing stent diameter (p < 0.001).

Conclusions:

  • Premounted stent implantation (PMS) offers an effective short-term solution for pediatric branch pulmonary artery stenosis (BPAS).
  • Early transcatheter reintervention is often necessary for growth, but high rates of surgical stent intervention (SSI) are noted.
  • Long-term management requires careful consideration due to the need for repeat procedures and potential complications.
Abstract

Keywords:
branch pulmonary artery stenosischildrenpremounted stent

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