Pulmonary artery stents: Long-term follow-up (original) (raw)
Related papers
Stent implantation for relief of pulmonary artery stenosis: Immediate and shortâterm results
Catheterization and Cardiovascular Diagnosis, 1996
Our objective was to assess the immediate and short-term results of stent implantation to relieve pulmonary artery stenosis (PAS). Thirty-seven patients underwent an attempt at stent implantatlon at a medlan age of 7.0 years (range, 0.G31.4 years) and a median weight of 20.5 kg (range, 7.4-85 kg). Twenty-two patients had previous tetralogy of Fallot repair. A total of 55 stents were Implanted successfully in 36 patlents. The peak systolic gradient across the stenotic segment decreased from a mean of 43 2 20.4 mmHg prestent to 13 f 13.9 mmHg (P a:: 0.001) poststent. The diameter of the narrowest segment Increased from a mean of 4.8 f 1.6 mm to 10.5 f 2.6 mm (P ,:I 0,001). The right ventrlcular-to-aortic mean systolic pressure ratio decreased from 0.74 2 0.2 to 0.52 ? 0.1 9 (P c: 0.001). Complications included balloon rupture prior to full stent expansion in 4 patients (in 2 patients the stent was positioned in the superior vena cava, and in 2 in the inferior vena cava), distal migration of a stent which was successfully retrieved at surgery 1 mo later in 1 patient, and tethering of the stent to the balloon requiring surgical removal in 1 patient. One patient died several hours after stent placement. Sixteen patients underwent repeat catheterization at a mean follow-up interval 010.9 * 0.5years (range, 0.2-2.0years). The mean gradient across the stent for these 16 patients was 26.7 f 19.8 mmHg, and there was no change in the mean diameter (9.4 2 3.2 mm). Two patients developed stenosis related to neointimal proliferation at the stent site which was redilated successfully. In conclusion, stent irnplantation is generally safe and effective in relleving PAS.
Pulmonary artery stents in the recent era
Catheterization and Cardiovascular Interventions, 2014
Background: Long-term follow-up after stent dilation of native and acquired pulmonary artery stenosis is scarce in the pediatric population. Most cohorts include a myriad of anatomies and associated conditions. Method: In order to establish objective performance criteria, we performed a retrospective review of all patients who underwent unilateral pulmonary artery stenting in biventricular physiology at three centers from June 2006 to June 2011. Results: Fifty-eight patients received 60 stents with Palmaz Genesis stent used most commonly (78%). Average age at implantation was 10.4 6 10.3 years and weight 31.6 6 21.8 kg. The immediate success rate was 98%, with improvement in minimal diameter from 5.1 6 2 cm to 10.6 6 3 cm (P < 0.01). There were 10 complications (7 major and 3 minor) and no acute mortality. One-year follow-up studies were available in 48 patients (83%), including echocardiogram (60%), catheterization (28%), MRI (29%), and lung perfusion (31%). Follow-up echocardiogram showed mild increase in stent gradient, from 5.7 6 6.7 mm Hg post-procedure to 17.1 6 11.7 mm Hg. Follow-up catheterization showed no significant change in minimal stent diameter (8.8 6 2.6 to 7.8 6 2.3 mm), gradient (7.7 6 8.4 to 12.6 6 12.2 mm Hg), or right ventricular pressures (43.7 6 9 to 47.7 6 10.5 mm Hg). Nine patients (16%) underwent scheduled stent redilation over a period of 12 days to 25 months. Conclusion: In conclusion, stent implantation shows excellent immediate and 1-year follow-up results with maintenance of improved caliber of the stented vessel and lowered right ventricular systolic pressures. V
Cardiology in the Young, 2002
Introduction: There is limited data on medium to long-term outcome, and the morbidity and mortality associated with the implantation, of pulmonary arterial stents. Purpose: To assess changes in morbidity and mortality over the last two decades. Methods: Retrospective analysis of all patients stented between September, 1989 and July, 2001. Results: We implanted 664 Palmaz stents in 338 patients. The overall number included 229 patients who had undergone repair of tetralogy of Fallot, in whom 468 stents were implanted, 61 patients with congenital stenosis of the branches of the pulmonary trunk, in whom we placed 115 stents, 16 patients after an arterial switch operation who had 38 stents, and 32 patients after the Fontan operation who had 43 stents implanted. The mean age was 12.2 years, and the mean weight was 38 kg. The mean systolic pressure gradient decreased from 41 to 8.7 mmHg, the mean diameter of the stented vessel increased from 5.4 to 11.2 mm, and the ratio of right ventricu...
The outcome of pulmonary artery stents following surgical manipulation
Catheterization and Cardiovascular Interventions, 2011
Background: Pulmonary artery (PA) stents are utilized to treat branch pulmonary stenosis (BPS). Often patients with PA stents undergo subsequent cardiac surgery for other indications, and the stents can be manipulated during the procedure. Objective: The purpose of this study was to evaluate the outcome of branch PA stenoses following surgical manipulation of previously implanted PA stents and to determine factors associated with future reintervention. Methods: Catheterization data, operative reports, and clinical summaries were reviewed on patients with PA stents placed between September 1989 and December 2006 undergoing subsequent cardiac surgery. Surgical manipulation was recorded as removed, trimmed, or longitudinally transected, and patched. Those that were not manipulated were defined as untouched. Results: 459 patients had branch PA stents placed. About 54 patients, with 70 stents in branch PA's. subsequently had further cardiac surgery. The median age of stent placement was 7.5 (0.5-32.4) years with a median age of surgery of 12.7 (5.1-39.6) years. Surgical manipulation was performed in 23 (33%) PA's and 47 (66%) stents were untouched. Stent removal occurred in 11 (16%), with transecting longitudinally and patching in 5 (7%), and trimming in 7 (10%). Comparing the surgical manipulation and the untouched groups, there was no difference in median age of stent placement [7.2 (0.5-30.2) versus 7.6 (1.8-32.4) years, p 5 0.40], wt [21.0 (5.3-86.5) versus 24.7 (9.0-96.0) kg, p 5 0.42], or residual catheterization gradient across the stent [3 (0-59) versus 4 (0-50) mmHg, p 5 0.81]. Catheter reintervention (stent n 5 6 or balloon dilation n 5 14) on the previously stented PAs was similar between the surgically manipulated (median 7.5 years) and untouched groups (median 11.5 years) (p 5 0.31). In multivariate analysis, the factors associated with future catheter reintervention were having the stent transected longitudinally and patched (p 5 0.003) and a lower weight (p 5 0.006) at the time of stent placement. Conclusions: Surgical stent manipulation is often performed in patients who have PA stents. Surgical manipulation does not alter the need for future reintervention and catheter re-intervention may be more likely when the stents are transected longitudinally and patched. V C 2010 Wiley-Liss, Inc.
Long-term outcomes of intraoperative pulmonary artery stent placement for congenital heart disease
Catheterization and Cardiovascular Interventions, 2011
Objective: Our objective was to examine long-term outcomes of intraoperative pulmonary artery stents and determine risk factors for reintervention Background: Short-term outcomes of intraoperative pulmonary artery stents have been reported previously. However, long-term results are unknown. Methods: We conducted a retrospective review of patients who underwent intraoperative pulmonary artery stent placement for branch pulmonary artery stenosis. Results: Ninety-six stents were implanted intraoperatively in 67 patients. Twenty-seven patients received two or more stents at initial intervention. Median patient age at initial stent placement was 1.8 years. Median post-inflation diameter was 8 mm. At a mean follow-up of 7.6 6 4.5 years, 49% of stents required reintervention (balloon angioplasty at catheterization in 28 patients and surgical revision in 19 patients). Actuarial freedom from reintervention at 2, 5, and 10 years was 68%, 49%, and 40%, respectively. In univariate analysis of time to first reintervention, age at implantation < 2 yrs (P < 0.0009) and initial post-inflation stent diameter < 10 mm (P < 0.0002) were associated with risk for reintervention. Multivariable Cox regression analysis showed age < 2 years (P < 0.005) and diagnosis of tetralogy of Fallot (p < 0.002) or truncus arteriosus (P < 0.007) to be significant risk factors for reintervention. Conclusion: Intraoperative placement of stents in the pulmonary arteries is an alternative to surgical angioplasty, but is associated with a high incidence of reintervention. Age < 2 years and the diagnosis of tetralogy of Fallot or truncus arteriosus are risk factors for reintervention. V C 2010 Wiley-Liss, Inc.
Catheterization and Cardiovascular Interventions, 2009
Background: Balloon angioplasty of bifurcating pulmonary artery (PA) stenoses is often inadequate, and stent treatment often requires simultaneous implantation of two stents. This study evaluates initial results and long-term follow up of transcatheter stent placement in bifurcating PAs. Methods: This is a retrospective review of patients (pts) who had bifurcating PA stents placed in main and lobar branches from 1993 to 2007. Results: Forty-nine pts had bifurcating PA stents placed at a median age of 10.9 years (range 1-43 years). The mean minimum vessel diameter increased from 5.7 6 2.5 mm to 11.0 6 3.6 mm (P < 0.001), the mean gradient across the stenoses decreased from 37.0 6 26.9 to 9.2 6 13 mm Hg (P < 0.001), whereas the mean RV:FA ratio decreased from 0.76 6 0.29 to 0.53 6 0.24 (P < 0.001). There was one death due to severe pulmonary hemorrhage. F/U data were available in 38 pts (mean duration 6.3 6 4.1 years, range 1.2-13.1 years). Thirty pts underwent repeat catheterizations (mean 2.3 6 2.2 years poststent), with 26 requiring further interventions: Fifteen had balloon angioplasty alone and 11 had additional stents placed. There were no complications at f/u catheterization. Six pts underwent further palliative surgeries, although none for repair of branch PA stenoses. Conclusions: Simultaneous transcatheter placement of bifurcating PA stents provides immediate gradient relief of bifurcating stenoses in the proximal or lobar branch PAs and reduces RV systolic pressure. Further interventions can be safely performed in future procedures, and the presence of stents does not complicate future surgeries. '
Circulation. Cardiovascular interventions, 2009
Stents are essential tools in the management of pulmonary arterial (PA) stenosis in patients with congenital heart disease. Although stents can usually be reexpanded as children grow, resistant in-stent or peri-stent obstruction can complicate the management of PA stents. Angioplasty with ultra-high-pressure (UHP) balloons may facilitate successful treatment of stent-associated PA stenoses that are resistant to high-pressure dilation. We reviewed patients who underwent UHP angioplasty of in-stent or peri-stent PA stenoses that were resistant to high-pressure redilation. A resistant stenosis was defined as a residual balloon waist during high-pressure redilation of the stent, along with a pressure gradient and/or angiographic stenosis. Thirty-four lesions in 29 patients, including 8 with multiple concentric, overlapping, or adjacent stents, were included. The median age at UHP angioplasty was 9 years, and a median of 4 years had elapsed since unsuccessful high-pressure angioplasty. T...
Pulmonary artery stents: Past, present and future
Progress in Pediatric Cardiology, 2012
Stents can be used to treat many forms of congenital heart disease, however, the majority of use remains in the pulmonary arterial system. Initial experimental work in the 1990's proved that stents were an effective means for treating pulmonary artery stenosis. Subsequent experience demonstrated ways to overcome the limitations of small children, bifurcating stenoses, jailed side branches and the ways to cope with potential complications. We review the use of stents to rehabilitate the pulmonary arterial tree and outline the acute and long-term results. Finally, we discuss the potential improvements and opportunities with bioabsorbable stents and other future directions for bare metal stents as well.
Various reasons for repeat dilatation of stented pulmonary arteries in paediatric patients
Heart (British Cardiac Society), 2002
To evaluate the reasons for repeat intervention in patients treated with balloon expandable stents for pulmonary artery stenoses, with particular analysis of the time intervals between interventions. A retrospective observational study. A single paediatric cardiology centre. 38 patients, mean age 6.9 years, range 6 days to 34 years (one adult patient); mean weight 19.7 kg, range 2.5-75 kg. Implantation of balloon expandable stents in 46 cases of main pulmonary artery stenosis, right pulmonary artery stenosis, left pulmonary artery stenosis, or right ventricle to pulmonary artery conduits. Adaptation of stent diameter to patient growth; development of pulmonary arteries; pressure gradient in the right ventricle. 56 stents were implanted in 46 lesions. During a mean follow up time of 2.2 years, 40 repeat dilatations were performed on 28 of 42 reinvestigated stents. A second repeat dilatation was performed on eight stents, and a third on four stents. The mean time period between implan...