HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH TABLE OF CONTENTS		QUICK SEARCH:   [advanced] Author: Keyword(s): Year:  Vol:  Page:

This Article Full Text Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Add to Personal Folders Download to citation manager Author home page(s): Christopher A. Caldarone W. G. Williams Permission Requests Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Ovaert, C. Articles by Benson, L. N. Search for Related Content PubMed PubMed Citation Articles by Ovaert, C. Articles by Benson, L. N.

J Thorac Cardiovasc Surg 1999;118:886-893
© 1999 Mosby, Inc.

SURGERY FOR CONGENITAL HEART DISEASE

ENDOVASCULAR STENT IMPLANTATION FOR THE MANAGEMENT OF POSTOPERATIVE RIGHT VENTRICULAR OUTFLOW TRACT OBSTRUCTION: CLINICAL EFFICACY

From the Departments of Pediatrics and Surgery, Divisions of Cardiology^a and Cardiovascular Surgery,^b and the Variety Club Cardiac Catheterization Laboratories, The Hospital for Sick Children, The University of Toronto School of Medicine, Toronto, Ontario, Canada.

Address for reprints: Lee N. Benson, MD, The Hospital for Sick Children, 555 University Ave, Toronto, Ontario, Canada M5G 1X8 (E-mail: benson{at}sickkids.on.ca).

Objective: Extracardiac conduits between the right ventricle and pulmonary arteries commit patients to multiple reoperations. We reviewed our experience with stent implantation in obstructed conduits.
Methods: Between 1990 and 1997, stents were implanted across 43 conduits. The median age at procedure was 6 years (0.5-17 years), and the median interval between conduit insertion and stent implantation was 2.4 years (0.3-14 years).
Results: Mean systolic right ventricular pressures and gradients, respectively, decreased from 71 ± 18 mm Hg and 48 ± 19 mm Hg before to 48 ± 15 mm Hg and 19 ± 13 mm Hg after stent placement. Mean percentage of predicted valve area for body surface area increased from 26% ± 12% to 48% ± 17% after stent placement. Fifteen patients underwent a second transcatheter intervention (dilation or additional stent), and 2 patients, a third, allowing further postponement of surgery in 8 patients. One sudden death occurred 2.8 years after stent placement. Surgical conduit replacement has occurred in 20 patients. Body growth was maintained during follow-up. Freedom from surgical reintervention was 86% at 1 year, 72% at 2 years, and 47% at 4 years. Higher right ventricular pressure and gradient before and after stent placement and lower percentage of predicted valve area for body surface area after stent placement were associated with shorter palliation.
Conclusion: Endovascular stent placement across obstructed conduits is a safe and effective palliation that allows for normal body growth.

This article has been cited by other articles:

				E. M. Zahn, W. E. Hellenbrand, J. E. Lock, and D. B. McElhinney Implantation of the melody transcatheter pulmonary valve in patients with a dysfunctional right ventricular outflow tract conduit early results from the u.s. Clinical trial. J. Am. Coll. Cardiol., October 27, 2009; 54(18): 1722 - 1729. [Abstract] [Full Text] [PDF]

				J. Nordmeyer, S. Khambadkone, L. Coats, S. Schievano, P. Lurz, G. Parenzan, A. M. Taylor, J. E. Lock, and P. Bonhoeffer Risk Stratification, Systematic Classification, and Anticipatory Management Strategies for Stent Fracture After Percutaneous Pulmonary Valve Implantation Circulation, March 20, 2007; 115(11): 1392 - 1397. [Abstract] [Full Text] [PDF]

				S. Aggarwal, S. Garekar, T. J. Forbes, and D. R. Turner Is Stent Placement Effective for Palliation of Right Ventricle to Pulmonary Artery Conduit Stenosis? J. Am. Coll. Cardiol., January 30, 2007; 49(4): 480 - 484. [Abstract] [Full Text] [PDF]

				R.-E. W. Kavey Optimal Management Strategies for Patients With Complex Congenital Heart Disease Circulation, June 6, 2006; 113(22): 2569 - 2571. [Full Text] [PDF]

				L. F. Peng, D. B. McElhinney, A. W. Nugent, A. J. Powell, A. C. Marshall, E. A. Bacha, and J. E. Lock Endovascular Stenting of Obstructed Right Ventricle-to-Pulmonary Artery Conduits: A 15-Year Experience Circulation, June 6, 2006; 113(22): 2598 - 2605. [Abstract] [Full Text] [PDF]

				A. Laudito, V. M. Bandisode, J. F. Lucas, W. A. Radtke, W. T. Adamson, and S. M. Bradley Right Ventricular Outflow Tract Stent as a Bridge to Surgery in a Premature Infant with Tetralogy of Fallot Ann. Thorac. Surg., February 1, 2006; 81(2): 744 - 746. [Abstract] [Full Text] [PDF]

				C. Schreiber, R. Bauernschmitt, N. Augustin, P. Libera, R. Busley, A. Eicken, and R. Lange Implantation of a Prosthesis Mounted Inside a Self-Expandable Stent in the Pulmonary Valvar Area Without Use of Cardiopulmonary Bypass Ann. Thorac. Surg., January 1, 2006; 81(1): e1 - e3. [Abstract] [Full Text] [PDF]

				S. Khambadkone, L. Coats, A. Taylor, Y. Boudjemline, G. Derrick, V. Tsang, J. Cooper, V. Muthurangu, S. R. Hegde, R. S. Razavi, et al. Percutaneous Pulmonary Valve Implantation in Humans: Results in 59 Consecutive Patients Circulation, August 23, 2005; 112(8): 1189 - 1197. [Abstract] [Full Text] [PDF]

				H Sugiyama, W Williams, and L N Benson Implantation of endovascular stents for the obstructive right ventricular outflow tract Heart, August 1, 2005; 91(8): 1058 - 1063. [Abstract] [Full Text] [PDF]

				C. A. C. Pedra, H. Justino, D. G. Nykanen, G. V. MD, J. G. Coles, W. G. Williams, R. M. Freedom, and L. N. Benson Percutaneous stent implantation to stenotic bioprosthetic valves in the pulmonary position J. Thorac. Cardiovasc. Surg., July 1, 2002; 124(1): 82 - 87. [Abstract] [Full Text] [PDF]

				B. Aupecle, A. Serraf, E. Belli, S. Mohammadi, F. Lacour-Gayet, P. Fornes, and C. Planche Intermediate follow-up of a composite stentless porcine valved conduit of bovine pericardium in the pulmonary circulation Ann. Thorac. Surg., July 1, 2002; 74(1): 127 - 132. [Abstract] [Full Text] [PDF]

				P. Bonhoeffer, Y. Boudjemline, S. A. Qureshi, J. Le Bidois, L. Iserin, P. Acar, J. Merckx, J. Kachaner, and D. Sidi Percutaneous insertion of the pulmonary valve J. Am. Coll. Cardiol., May 15, 2002; 39(10): 1664 - 1669. [Abstract] [Full Text] [PDF]

				N. Sinzobahamvya, J. Wetter, H. C. Blaschczok, M.-Y. Cho, A. M. Brecher, and A. E. Urban The fate of small-diameter homografts in the pulmonary position Ann. Thorac. Surg., December 1, 2001; 72(6): 2070 - 2076. [Abstract] [Full Text] [PDF]

				R. M. Ungerleider, T. A. Johnston, M. P. O'Laughlin, J. J. Jaggers, and P. R. Gaskin Intraoperative stents to rehabilitate severely stenotic pulmonary vessels Ann. Thorac. Surg., February 1, 2001; 71(2): 476 - 481. [Abstract] [Full Text] [PDF]

				C. A. Caldarone, B. W. McCrindle, G. S. Van Arsdell, J. G. Coles, G. Webb, R. M. Freedom, and W. G. Williams Independent factors associated with longevity of prosthetic pulmonary valves and valved conduits J. Thorac. Cardiovasc. Surg., December 1, 2000; 120(6): 1022 - 1031. [Abstract] [Full Text] [PDF]

				F. L. Hanley EDITORIAL: MANAGEMENT OF THE CONGENITALLY ABNORMAL RIGHT VENTRICULAR OUTFLOW TRACT--WHAT IS THE RIGHT APPROACH? J. Thorac. Cardiovasc. Surg., January 1, 2000; 119(1): 1 - 3. [Full Text] [PDF]