Quandt D, Callegari A, Niesse O, Meinhold A, Dave H, Knirsch W, Kretschmar O.
J Card Surg. 2022 Oct 23. doi: 10.1111/jocs.17057. Online ahead of print.
Take Home Points:
- Balloon angioplasty and stent implantation can be performed safely in immediate post-operative period.
- Stent implantation more reliably achieves relief of vessel stenosis.
Commentary from Dr. Konstantin Averin (Cohen Children’s Heart Center), catheterization section editor of Pediatric Cardiology Journal Watch:
Interventional cardiac catheterization in the immediate post-operative period is generally considered high risk. The traditional teaching has been to delay intervention for 4-6 weeks after the operation to allow for healing and scar formation. However, there is increasing data to suggest that intervention early after congenital heart surgery has a favorable risk profile if performed selectively. Quandt et al sought to report on the safety and efficacy of balloon angioplasty (BAP) and stent implantation (SI) within 30 days post-congenital heart surgery (CHS) in children from a single center.
Over a 20-year period (01/2001-01/2021) a total of 127 procedures were performed in 104 patients – 31 BAP and 96 SI with no significant differences in baseline demographics. The median time from CHS to the intervention was 6.5 days but patients who underwent SI were only 4 days removed from CHS compared to 14 for BAP. SI resulted in greater increase in vessel diameter both in absolute size and relative to adjacent structures. SI also achieved an increase diameter of >50% more often than BAP (94% v 70%). The rate of major complications was modest (4.8%) with no intra-procedural mortality. There was one case in which the authors suspect rupture of a suture line requiring VA-ECMO use with full recovery. There was no relationship between adverse events and severity of the stenosis.
The authors conclude that BAP and SI is feasible and effective following CHS. SI appears to provide more reliable relief of stenosis compared to BAP and should be favored when treating these critically ill infants. These insights have the potential to guide clinicians in providing optimal care for children with congenital heart disease during the critical early postoperative period.