title: Effect of endovascular stenting of right ventricle to pulmonary artery conduit stenosis in infants with hypoplastic left heart syndrome on stage II outcomes.
abstract: There is growing awareness that the Norwood procedure with the Sano modification is prone to early right ventricular to pulmonary artery (RV-PA) conduit stenosis resulting in systemic oxygen desaturation, increased interstage morbidity, and death. We report our experience with endovascular stent placement for conduit stenosis and compare the outcomes at stage II surgery between stented and nonstented infants. The medical records of all patients with hypoplastic left heart syndrome who received an RV-PA conduit at Norwood palliation from May 2005 to January 2010 were reviewed. The preoperative anatomy, demographics, operative variables, and outcomes pertaining to the Norwood and subsequent stage II surgeries were obtained and compared between stented and nonstented infants. The pre- and post-stent oxygen saturation, stenosis location, type and number of stents implanted, concomitant interventions, procedure-related complications, and reinterventions were collected. Of the 66 infants who underwent the Norwood procedure with RV-PA conduit modification, 16 (24%) received stents. The anatomy, demographics, and outcome variables after the Norwood procedure were similar between the stented and nonstented infants. The age at catheterization was 93 ± 48 days, and the weight was 4.9 ± 1.2 kg. The oxygen saturation increased from 66 ± 9% before intervention to 82 ± 6% immediately after stenting (p <0.0001). No interstage surgical shunt revisions were performed in either group. Age, weight, pre-stage II echocardiographic variables, oxygen saturation, and operative and outcome variables, including mortality, were similar between the 2 groups. In conclusion, endovascular stent placement for RV-PA conduit stenosis after the Norwood procedure leads to improved systemic oxygen levels and prevents early performance of stage II surgery without compromising stage II outcomes.
authors.affiliation: University of Utah, Salt Lake City, UT, USA. robert.gray@imail.org
authors.forename: Robert G
authors.initials: RG
authors.lastname: Gray
authors.forename: L Luann
authors.initials: LL
authors.lastname: Minich
authors.forename: Hsin Yi
authors.initials: HY
authors.lastname: Weng
authors.forename: Mason C
authors.initials: MC
authors.lastname: Heywood
authors.forename: Phillip T
authors.initials: PT
authors.lastname: Burch
authors.forename: Collin G
authors.initials: CG
authors.lastname: Cowley
mesh_terms: D000714:Anastomosis, Surgical; D000792:Angiography; D001157:Arterial Occlusive Diseases / Q000150:complications / Q000175:diagnosis / Q000601:surgery*; D006328:Cardiac Catheterization; D002675:Child, Preschool; D004452:Echocardiography; D057510:Endovascular Procedures / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D006352:Heart Ventricles / Q000601:surgery*; D006801:Humans; D018636:Hypoplastic Left Heart Syndrome / Q000150:complications / Q000175:diagnosis / Q000601:surgery*; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D058327:Norwood Procedures / Q000379:methods*; D011651:Pulmonary Artery / Q000000981:diagnostic imaging / Q000601:surgery*; D012189:Retrospective Studies; D015607:Stents; D016896:Treatment Outcome