Simultaneous stent implantation for pulmonary artery bifurcation stenosis in infants
Kristin T Fujita1, Oliver M Barry1, Alejandro J Torres1
1Division of Pediatric Cardiology, Department of Pediatrics, Columbia University Irving Medical Center, Morgan Stanley Children's Hospital, New York, NY, USA.
Insights
Simultaneous pulmonary artery (PA) stent placement effectively relieves bifurcation stenosis in infants, reducing pressure gradients and improving vessel diameter. While re-intervention is often needed due to growth, this procedure can delay further operations.
Area of Science:
- Cardiology
- Pediatric Interventional Cardiology
- Vascular Surgery
Background:
- Pulmonary artery (PA) bifurcation stenosis presents a significant challenge, often necessitating simultaneous stent placement.
- Data on the safety and efficacy of this complex procedure in infants are limited.
Purpose of the Study:
- To evaluate the procedural outcomes and safety of simultaneous stent placement for PA bifurcation stenosis in infants.
- To assess the impact of this intervention on hemodynamic parameters and vessel dimensions.
Main Methods:
- A single-center retrospective review was conducted on infants (<12 months) undergoing simultaneous PA bifurcation stent placement between 2001 and 2019.
- Procedural success, hemodynamic changes, vessel diameter, and adverse events were analyzed.
Main Results:
- Seventeen infants (median age 6.4 months) underwent the procedure, with most stents placed in central PAs.
- Significant reductions in peak gradient (47.4 to 18.7 mm Hg) and RV/systemic pressure ratio (1.0 to 0.58) were observed (P<.0001).
- Minimum vessel diameter increased (3.6 to 6.0 mm, P<.0001), with 4 patients experiencing severe adverse events and no procedure-related deaths.
Conclusions:
- Simultaneous PA stent placement is an effective treatment for infant PA bifurcation stenosis.
- While transcatheter interventions are necessary for growth, they may postpone the need for re-operation.
Objectives:
Pulmonary artery (PA) bifurcation stenosis often requires simultaneous stent placement, which may be technically challenging. Limited data exist regarding this practice in infants. We aim to report the procedural outcomes and safety of bifurcation stent placement in infants.
Methods:
We performed a single-center retrospective review of infants younger than 12 months who underwent simultaneous stent placement for PA bifurcation stenosis from January 1, 2001 through December 31, 2019.
Results:
Seventeen infants underwent simultaneous PA bifurcation stent placement. The median age was 6.4 months (1.1-10.1 months), and weight was 5.8 kg (3-10.6 kg). Nine (52.9%) patients had had prior PA intervention. Most stents were placed in central PAs (28, 82.4%), followed by lobar branches (6, 17.6%). All patients received pre-mounted stents. The peak gradient across each branch decreased from 47.4 ± 16 to 18.7 ± 13 mm Hg (P less than .0001). The right ventricle to systemic systolic pressure ratio decreased from systemic (1.0 ± 0.3) to just over half systemic (0.58 ± 0.2) (P = .0001). The minimum vessel diameter increased from 3.6 ± 1.5 to 6.0 ± 1.9 mm (P less than .0001). There were 4 (23.5%) patients with high severity adverse events. There were no procedure-related deaths. The median follow-up period was 83.8 months (5.3 months-19.4 years). All patients had subsequent PA re-intervention at a median time of 8.1 months (2.9 months-8.8 years), and median time to re-operation was 19.1 months (2.9 months-7.5 years).
Conclusions:
Simultaneous PA stent placement is an effective strategy for relief of bifurcation stenosis in infants. Future transcatheter interventions are necessary to account for patient growth, but may delay the need for re-operation.
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