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.
Department of Pediatric Cardiology, University of Alabama at Birmingham, Birmingham, Alabama, USA.
Mark A
MA
Law
Pirouz
P
Shamszad
Alan W
AW
Nugent
Henri
H
Justino
John P
JP
Breinholt
Charles E
CE
Mullins
Frank F
FF
Ing
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