Pulmonary artery stents: long-term follow-up.
OBJECTIVE
Determine the long-term outcomes of branch pulmonary artery (PA) stents.


BACKGROUND
PA stents in congenital heart disease effectively relieve stenoses in the short-term. Published long-term data are limited.


METHODS
Patients enrolled in an FDA IDE protocol from 1989-92 were included. Clinical follow-up and catheterization data were evaluated. Patients were included if >5 year follow-up data was available or if mortality occurred following the initial procedure.


RESULTS
There were five deaths: four due to progression of their underlying heart disease, and one from a complication during a follow-up catheterization. Clinical data for 43 surviving patients demonstrated 39 patients (91%) are in NYHA class I or II. Seven patients underwent surgical intervention during the follow-up period (five RV-PA conduit, two Fontan revisions), but none addressed PA stenosis. Final repeat catheterizations were performed in 36 patients (55 stents) 7.2 +/- 4.3 years post stent insertion with 1.2 +/- 0.9 further procedures with stent dilations. In this subgroup, the minimum vessel diameter increased from 4.7 +/- 1.8 to 13.4 +/- 2.4 mm (P < 0.001), and the pressure gradient improved from 41 +/- 25 to 9 +/- 11 mm Hg (P < 0.001). Higher initial gradient and smaller balloons were associated with a final stent diameter of <14 mm (P = 0.030 and 0.046). Jailed vessels occurred in 49% of stents with abnormal angiographic flow in 18/55. Six repeat catheterizations resulted in complications, including the one procedural death.


CONCLUSIONS
Stents implants for PA stenoses provide effective improvement in vessel caliber in the long-term. Although repeat interventions are necessary, this procedure reduces RV pressure and provides an important alternative to surgery for residual PA obstruction.
Law
Mark A
MA
Department of Pediatric Cardiology, University of Alabama at Birmingham, Birmingham, Alabama, USA.
Shamszad
Pirouz
P
Nugent
Alan W
AW
Justino
Henri
H
Breinholt
John P
JP
Mullins
Charles E
CE
Ing
Frank F
FF
D000293:Adolescent; D000800:Angioplasty, Balloon / Q000009:adverse effects / Q000295:instrumentation* / Q000401:mortality; D001157:Arterial Occlusive Diseases / Q000175:diagnosis / Q000401:mortality / Q000503:physiopathology / Q000628:therapy*; D006348:Cardiac Surgical Procedures; D002648:Child; D002675:Child, Preschool; D003251:Constriction, Pathologic; D005260:Female; D005500:Follow-Up Studies; D006330:Heart Defects, Congenital / Q000175:diagnosis / Q000401:mortality / Q000503:physiopathology / Q000628:therapy*; D006439:Hemodynamics; D006801:Humans; D008297:Male; D011474:Prosthesis Design; D011475:Prosthesis Failure; D011651:Pulmonary Artery / Q000000981:diagnostic imaging / Q000254:growth & development / Q000503:physiopathology; D011859:Radiography; D020127:Recovery of Function; D015607:Stents; D013997:Time Factors; D016896:Treatment Outcome; D014463:Ultrasonography