Hybrid Stenting of Hypoplastic Pulmonary Arteries in Surgical Repair of Complex CHD

Vladimir V. Losev, Manolis G. Pursanov, Mikhail R. Chiaureli , Konstantin V. Shatalov, David O. Berishvili, Alexey I. Kim, Andrey V. Sobolev, Irina V. Arnautova, Ashot O. Baveyan

A.N. Bakoulev Scientific Center for Cardiovascular Surgery, Moscow, Russia

Date, time and location: 2018.05.26 15:30, Exhibition area, 1st Floor. Zone – A

Abstract

Objective: to determine results and efficiency of hybrid stenting of the pulmonary artery in patients with various CHD with obstructive pathology of the pulmonary artery (PA).

Methods: hybrid stenting of the PA was performed in 24 patients (26 lesions) with various CHD. Patient age was from 10 month to 19 years (median 4,4+4,6) and weight from 5,3 to 77 kg (median 18,6+18,7). Hybrid stenting was performed in 14 patients (58,3%) under 3 years old (y.o.), in 4 (16,7%) – from 3 to 6 y.o. and in 6 (25%) – older than 6 y.o. In 7 (29,2%) patients PA stenting was performed during hemodynamic correction of CHD, in 5 (20,8%) – during primal surgical repair of CHD, in 6 (25%) – in patients with complications after surgical repair of CHD and in 6 (25%) – in patients with hypoplastic left heart syndrome. As an emergency procedure, 6 operations were performed and 18 – as a scheduled surgery. Stenting of left PA was performed in 18 cases, of right PA – in 7 cases and in 1 case - stenting of the pulmonary trunk.

Results: in 23 (95,8%) of 24 patients hybrid stenting was effective. In 1 case (4,2%) after balloon expansion, stent migrated to the proximal part of the left LA which resulted in surgical removal and repair of the left PA ostium. After stent implantation in all cases, we achieved a complete management of the PA obstruction. Only one patient (after primal repair of the PA atresia) died due to MODS in short follow-up period.

Conclusion: intraoperative hybrid stenting is an effective and save procedure. Vascular access should be determined individually, according to patient anatomy and morphological specifics of CHD. Hybrid procedures allow more effective and safe hemodynamic and primal surgical repair. In cases of complications, they can be managed with direct surgical intervention.