title: Hybrid intraoperative pulmonary artery stenting in redo congenital cardiac surgeries.
abstract: OBJECTIVE
  Reconstruction of branch pulmonary arteries (PAs) can be challenging in redo congenital heart surgeries. Treatment options like percutaneous stent implantation and surgical patch angioplasty may yield suboptimal results. We present our experience with hybrid intraoperative stenting which may be an effective alternative option.
  
  
  METHODS
  We retrospectively analyzed data of all patients with PA stenosis who underwent intraoperative PA branch stenting in our institution between January 2011 and December 2012.
  
  
  RESULTS
  Ten patients [6 females, median age 10 (1.4 to 37) years], underwent hybrid stenting of the PA. Primary cardiac diagnoses were pulmonary atresia with ventricular septal defect (VSD) in three patients, pulmonary atresia with intact ventricular septum in two, Tetralogy of Fallot (TOF) in one, Double outlet right ventricle (DORV) with pulmonary stenosis (PS) in one, complex single ventricle in two and VSD with bilateral branch PA stenosis in one patient. Concomitant surgeries were revision/reconstruction of RV-PA conduit in 4, Fontan completion in 4, repair of TOF with conduit placement in 1 and VSD closure in 1 patient. The left PA was stented in 7, the right in 2 and both in 1, with a total of 11 stents. There were no complications related to stent implantation. Two early postoperative deaths were unrelated to stent implantation. At mean follow-up period of 14.8 (12-26) months, stent position and patency were satisfactory in all survivors. None of them needed repeat dilatation or surgical reintervention.
  
  
  CONCLUSIONS
  Hybrid stenting of branch PA is a safe and effective option for PA reconstruction in redo cardiac surgeries. With meticulous planning, it can be safely performed without fluoroscopy.
authors.affiliation: Consultant Pediatric Cardiologist, Department of Pediatric Cardiology, Frontier Lifeline and Dr. K. M. Cherian Heart Foundation, R 30 C Ambattur Industrial Estate Road, Mogappair, Chennai 600 101, India. Electronic address: anuradhasridhar9@gmail.com.
authors.forename: Anuradha
authors.initials: A
authors.lastname: Sridhar
authors.affiliation: Department of Pediatric Cardiology, Frontier Lifeline and Dr. K. M. Cherian Heart Foundation, Chennai, India.
authors.forename: Raghavan
authors.initials: R
authors.lastname: Subramanyan
authors.affiliation: Department of Pediatric Cardiology, Frontier Lifeline and Dr. K. M. Cherian Heart Foundation, Chennai, India.
authors.forename: Rajasekaran
authors.initials: R
authors.lastname: Premsekar
authors.affiliation: Department of Pediatric Cardiology, Frontier Lifeline and Dr. K. M. Cherian Heart Foundation, Chennai, India.
authors.forename: Shanthi
authors.initials: S
authors.lastname: Chidambaram
authors.affiliation: Pediatric Cardiothoracic Surgery, Frontier Lifeline and Dr. K. M. Cherian Heart Foundation, Chennai, India.
authors.forename: Ravi
authors.initials: R
authors.lastname: Agarwal
authors.affiliation: Pediatric Cardiothoracic Surgery, Frontier Lifeline and Dr. K. M. Cherian Heart Foundation, Chennai, India.
authors.forename: Soman Rema Krishna
authors.initials: SR
authors.lastname: Manohar
authors.affiliation: Pediatric Cardiothoracic Surgery, Frontier Lifeline and Dr. K. M. Cherian Heart Foundation, Chennai, India.
authors.forename: K M
authors.initials: KM
authors.lastname: Cherian
mesh_terms: D000293:Adolescent; D000328:Adult; D006348:Cardiac Surgical Procedures / Q000009:adverse effects* / Q000379:methods; D002648:Child; D002675:Child, Preschool; D015331:Cohort Studies; D005260:Female; D005500:Follow-Up Studies; D006330:Heart Defects, Congenital / Q000000981:diagnostic imaging / Q000601:surgery; D006344:Heart Septal Defects, Atrial / Q000000981:diagnostic imaging / Q000601:surgery; D017052:Hospital Mortality; D006801:Humans; D007194:India; D007223:Infant; D007430:Intraoperative Care / Q000379:methods*; D008297:Male; D061214:Patient Safety; D011651:Pulmonary Artery / Q000601:surgery*; D011666:Pulmonary Valve Stenosis / Q000000981:diagnostic imaging / Q000601:surgery*; D012086:Reoperation / Q000379:methods; D012189:Retrospective Studies; D018570:Risk Assessment; D015607:Stents; D015996:Survival Rate; D013771:Tetralogy of Fallot / Q000000981:diagnostic imaging / Q000601:surgery; D016896:Treatment Outcome; D014463:Ultrasonography; D055815:Young Adult
keywords: Hybrid; Pulmonary artery; Redo surgery; Stent