title: "Intraoperative hybrid stenting of recurrent coarctation and arch hypoplasia with large stents in patients with univentricular hearts".
abstract: BACKGROUND
  Obstruction of the reconstructed aortic arch, tubular hypoplasia and recurrent coarctation (RC) is an important risk factor in univentricular physiology. For the past two years we have adopted the concept of intraoperative hybrid stenting of RC and arch hypoplasia with large stents in patients with univentricular hearts as standard care procedure.
  
  
  RESULTS
  Retrospective analysis of the anatomy and procedural outcome of 14 patients was scheduled for intraoperative stenting of the aortic arch (12 during surgery for BCPS, 2 during Fontan completion). The median age was 5.3 months, weight 5.5 kg, height 62 cm. Five patients had tubular hypoplasia and 9 patients had distal stenosis of the aortic arch. Nine patients had a previous balloon dilatation. The mean diameter of the distal arch was 11.0mm, at the coarctation 5.1mm, at the level of the diaphragm 8.2mm (CoA-index 0.62). Intraoperative stenting was performed in 13/14 patients. Stents were implanted with a mean balloon diameter of 10.8mm (SD 3.4mm). The achieved final mean diameter was 9.8mm (mean, SD 2.8mm) with an oversized Coa-index of 1.2. There was no re-coarctation at a mean follow-up of 7.3 months (range 3 to 24), the maximum flow velocity of 2m/s across the stented lesion assessed by ECHO.
  
  
  CONCLUSIONS
  This hybrid approach is an easy and safe concept to manage recurrent aortic arch hypoplasia and stenosis. The use of large stents allows redilatation to adult size diameters later on.
authors.affiliation: Department for Congenital Heart Defects, Ruhr University Bochum, Germany; Department for Pediatric Cardiology and Intensive Care, LMU-Campus Großhadern, Germany. Electronic address: Nikolaus.Haas@med.uni-muenchen.de.
authors.forename: Nikolaus A
authors.initials: NA
authors.lastname: Haas
authors.affiliation: Department for Congenital Heart Defects, Ruhr University Bochum, Germany.
authors.forename: Christoph M
authors.initials: CM
authors.lastname: Happel
authors.affiliation: Department for Surgery of Congenital Heart Defects, Heart and Diabetes Centre North Rhine Westphalia, Ruhr University Bochum, Germany.
authors.forename: Ute
authors.initials: U
authors.lastname: Blanz
authors.affiliation: Department for Congenital Heart Defects, Ruhr University Bochum, Germany.
authors.forename: Kai Thorsten
authors.initials: KT
authors.lastname: Laser
authors.affiliation: Department for Congenital Heart Defects, Ruhr University Bochum, Germany.
authors.forename: Marinos
authors.initials: M
authors.lastname: Kantzis
authors.affiliation: Department for Congenital Heart Defects, Ruhr University Bochum, Germany.
authors.forename: Deniz
authors.initials: D
authors.lastname: Kececioglu
authors.affiliation: Department for Surgery of Congenital Heart Defects, Heart and Diabetes Centre North Rhine Westphalia, Ruhr University Bochum, Germany.
authors.forename: Eugen
authors.initials: E
authors.lastname: Sandica
mesh_terms: D001013:Aorta, Thoracic / Q000000981:diagnostic imaging / Q000601:surgery*; D001017:Aortic Coarctation / Q000000981:diagnostic imaging / Q000601:surgery*; D006328:Cardiac Catheterization / Q000379:methods; D005260:Female; D005500:Follow-Up Studies; D006330:Heart Defects, Congenital / Q000000981:diagnostic imaging / Q000601:surgery; D006352:Heart Ventricles / Q000002:abnormalities* / Q000601:surgery*; D006801:Humans; D007223:Infant; D008297:Male; D016343:Monitoring, Intraoperative / Q000379:methods*; D011859:Radiography; D012008:Recurrence; D012189:Retrospective Studies; D015607:Stents
keywords: Coarctation; Hybrid surgery; Hypoplastic left heart syndrome; Intraoperative stenting; Large stents; Univentricular heart