title: Surgical Management of Vascular Stents in Pediatric Cardiac Surgery: Clues for a Staged Partnership.
abstract: Complex cases undergo step surgical and percutaneous procedures, including stent deployment. Concerns arise on stent removal at latest surgery. Our initial experience is presented. Forty-six stents in 35 patients were partially or totally removed at surgery. Univentricular heart was diagnosed in 20 patients. Stents were previously deployed in: ductus (6), right ventricle outflow tract (12), atrial septal defect (4), right pulmonary artery (4), left pulmonary artery (16), inferior vena cava (2), superior vena cava (1) and ascending aorta (1). Surgical procedures performed: 9 transplants, 6 Fontan, 4 Glenn, 1 comprehensive repair (Norwood + Glenn), 1 Glenn takedown, 8 conduit replacement, 2 Fallot, 2 Rastelli, 1 ventricular septal defect closure and 1 iatrogenic aortopulmonary window. Five ductal stents were clipped. Eleven stents in right ventricle, four ones in atrial septal defect, two in right pulmonary artery, seven in the left pulmonary artery and two in inferior vena cava were completely removed. Two stents in right pulmonary artery, one in superior vena cava, one in ascending aorta and nine in the left pulmonary artery were partially retrieved. Handling the stents in ductus, right ventricle and atrial septal defect was straightforward. On the contrary, stent removal in the ductus (comprehensive case), pulmonary branches, both vena cavae or aorta required short periods of deep hypothermia with circulatory arrest. Surgery over stents is increasing in complex, step procedures. Univentricular hearts are most prevalent. Congenital transplant surgery faces new challenges. Stent removal at the time of surgery may require deep hypothermic circulatory arrest.
authors.affiliation: Pediatric Cardiac Surgery, Hospital General Universitario Gregorio Marañón, C/O´Donnell 50, 28009, Madrid, Spain. giljaurena@gmail.com.
authors.forename: Juan-Miguel
authors.initials: JM
authors.lastname: Gil-Jaurena
authors.affiliation: Pediatric Cardiology, Hospital General Universitario Gregorio Marañón, Madrid, Spain.
authors.forename: José-Luis
authors.initials: JL
authors.lastname: Zunzunegui
authors.affiliation: Pediatric Cardiac Surgery, Hospital General Universitario Gregorio Marañón, C/O´Donnell 50, 28009, Madrid, Spain.
authors.forename: Ramón
authors.initials: R
authors.lastname: Pérez-Caballero
authors.affiliation: Pediatric Cardiac Surgery, Hospital General Universitario Gregorio Marañón, C/O´Donnell 50, 28009, Madrid, Spain.
authors.forename: Ana
authors.initials: A
authors.lastname: Pita
authors.affiliation: Pediatric Cardiac Surgery, Hospital General Universitario Gregorio Marañón, C/O´Donnell 50, 28009, Madrid, Spain.
authors.forename: María-Teresa
authors.initials: MT
authors.lastname: González-López
authors.affiliation: Pediatric Cardiology, Hospital General Universitario Gregorio Marañón, Madrid, Spain.
authors.forename: Fernando
authors.initials: F
authors.lastname: Ballesteros
authors.affiliation: Pediatric Cardiology, Hospital General Universitario Gregorio Marañón, Madrid, Spain.
authors.forename: Alejandro
authors.initials: A
authors.lastname: Rodríguez
authors.affiliation: Pediatric Cardiology, Hospital General Universitario Gregorio Marañón, Madrid, Spain.
authors.forename: Constancio
authors.initials: C
authors.lastname: Medrano
mesh_terms: D001011:Aorta / Q000601:surgery; D006348:Cardiac Surgical Procedures / Q000379:methods*; D006344:Heart Septal Defects, Atrial / Q000601:surgery*; D006352:Heart Ventricles / Q000002:abnormalities*; D006801:Humans; D010372:Pediatrics; D011446:Prospective Studies; D011651:Pulmonary Artery / Q000601:surgery*; D015607:Stents; D014683:Vena Cava, Superior / Q000601:surgery
keywords: Cardiac surgery; Hybrid; Pediatrics; Stent