Right ventricular outflow tract stenting for obstructive lesions in adult congenital heart disease

Currently, the use of stents in the right ventricular outflow tract (RVOT) has been described as alternative for palliation in neonates with Tetralogy of Fallot (ToF) and critical infundibular stenosis, who are not candidates for total correction in a single stage. However, there is limited evidence of the benefit of this intervention in other clinical scenarios, and just a few reports in adults. A retrospective study was conducted on 23 patients with significant RVOT obstruction who underwent RVOT stent placement and were not considered candidates for surgery. Patients 17 years old at the time of the procedure at our institution were included. Median age at the time of procedure was 24 years (IQR 17-49). 34.8% had univentricular heart physiology. The most frequent diagnosis was ToF (43.5%). 56.5% had at least one previous systemic-pulmonary shunt. In 69.5% of the cases the clinical context that led to stent placement was due to an emergency, primarily thrombosis of a systemic-pulmonary shunt (43.5%). RVOT stent implantation was successful in 100% of the cases. There were 2 procedure-related deaths (8.7%). The median stent patency time was 18.7 months (IQR 0-112 months). This is the first study that demonstrates the feasibility of RVOT stenting as a palliative method in adult patients with congenital heart disease in emergency settings. In addition to showing the possibility of its use in univentricular hearts, it demonstrates the long-term durability of RVOT stents as a palliative method, something never previously reported.