"Hybrid" stent delivery in the pulmonary circulation.

ABSTRACT

OBJECTIVE: We sought to describe our institutional experience providing "hybrid" intraoperative stent therapy for pulmonary artery (PA) stenoses. BACKGROUND: Surgical patch angioplasty, transcatheter stent therapy and intraoperative stent delivery are valuable treatment options for PA stenoses. The experience with intraoperative hybrid therapy has increased and new techniques and equipment have become available. METHODS: This study involves a retrospective review of 20 patients with a median age of 5.1 years who underwent hybrid PA stent therapy between March 2003 and April 2008. Thirteen patients had underlying diagnoses of either tetralogy of Fallot, pulmonary atresia with a ventricular septal defect (VSD) or truncus arteriosus. RESULTS: In 15 procedures, stents were implanted under direct vision. In 3 procedures, stents were implanted using vascular puncture with angiographic guidance, and in 2 procedures, stents were implanted using a combination of direct vision and fluoroscopy/angiography. Successful stent deployment was achieved in 18/20 (90%) procedures. One stent was malpositioned from the right ventricular outflow tract through a VSD, while another stent fractured as a result of high-pressure balloon expansion of a very resistant lesion. Adverse events were encountered in 3/20 (15%) procedures, which included the 2 "unsuccessful" stent deliveries. The median follow up thus far has been 1.7 years (41 days to 5.1 years). Seven of 20 (35%) patients required repeated interventions at the site of previous stent placement at a median interval of 8.5 months. CONCLUSIONS: Hybrid stent delivery in the operating room, using either direct vision or vascular puncture, is safe and effective. Using a well-equipped hybrid operating suite facilitates safe intraoperative stent delivery in a wide variety of patients. Close cooperation between the surgical and interventional teams is essential.