Long-term outcomes of intraoperative pulmonary artery stent placement for congenital heart disease.
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±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.


CONCLUSIONS
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.
Angtuaco
Michael J
MJ
Department of Pediatrics, University of Arkansas for Medical Sciences, Arkansas Children's Hospital, Pediatric Cardiology, Little Rock, Arkansas 72202, USA. mjangtuaco@uams.edu
Sachdeva
Ritu
R
Jaquiss
Robert D B
RD
Morrow
W Robert
WR
Gossett
Jeffrey M
JM
Fontenot
Eudice
E
Seib
Paul M
PM
D000293:Adolescent; D000367:Age Factors; D000800:Angioplasty, Balloon / Q000009:adverse effects / Q000295:instrumentation*; D001131:Arkansas; D001157:Arterial Occlusive Diseases / Q000150:complications / Q000628:therapy*; D006348:Cardiac Surgical Procedures / Q000009:adverse effects; D002648:Child; D002675:Child, Preschool; D003251:Constriction, Pathologic; D006330:Heart Defects, Congenital / Q000150:complications / Q000601:surgery*; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D007430:Intraoperative Care; D053208:Kaplan-Meier Estimate; D016016:Proportional Hazards Models; D011651:Pulmonary Artery; D012008:Recurrence; D019233:Retreatment; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D015607:Stents; D013997:Time Factors; D016896:Treatment Outcome; D055815:Young Adult