Authors: Luxford JC, Adams PE, Roberts PA, Mervis J.
Journal: Heart Lung and Circulation 2023 32, 638-644. Doi.org 10.1016
Take home points:
- Retrospective review of 20 patient (all < 3 months of age) from Sydney, Australia with primary RVOT stenting
- Average improvement with mean saturation increased from 80% to 91%.
- 18 survived (2 non cardiac deaths) with 12 requiring re intervention on the RVOT stent prior to open heart repair.
- All 18 achieved definitive repair at ~ 6 months of age.
- The need for more than one RVOT stent was associated with longer bypass and cross clamp.
Commentary from Dr. Thomas Zellers (Dallas, USA), section editor of Congenital Heart Disease Interventions and ACHD Journal Watch:
This is a retrospective study evaluating all patients undergoing RVOT stenting between January 2010 and December 2020. Only patients with native RVOT stenosis were included; no rescue, secondary implants or conduit implants were included in the analysis. The study was approved by the hospital Ethics Committee and statistics were summarized using standard statistical analysis on SPSS and GraphPad Prism software with a significant P value of < 0.05.
Catheterization technique involve the use of a 4Fr or 5Fr right coronary catheter, a coronary wire and delivery without a long sheath in the RVOT. The group switched from bare metal to covered stents during the study evaluation because it reduced intimal proliferation. Aspirin 5 mg/kg/day dosing was recommended if there was no contraindication. Follow up was continued to their surgery and until their last follow up unless they died prior to surgery.
The population included 12 with hypercyanotic spells and 8 who were PDA dependent and on prostaglandin. The majority were neonates and 8 were less than 2.5 kg, 18 were urgent procedures and 12 had a major co-morbidity or genetic syndrome.
There was one major complication with need for isoprenaline for heart block, which resolved with time.The stents were enlarged to an average of 5-6 mm and 18 of 20 survived (No cardiac deaths). Thirteen required reintervention prior to definitive repair. Only one required reintervention within a week of the original procedure. Pulmonary artery growth increased with time to nearly z scores < -1 or greater in the majority.
Tables:
Conclusions: RVOT stenting became the standard of care at this hospital with excellent results (better than standard BT shunts in their population) and could be performed in small neonates safely. The majority transitioned to covered stents which reduced intimal hyperplasia but did not change the time to definitive repair or reintervention. The pulmonary artery growth was normal but more than one RVOT stent increased the cross clamp and bypass time.
