Hostname: page-component-7c8c6479df-ws8qp Total loading time: 0 Render date: 2024-03-29T00:36:46.768Z Has data issue: false hasContentIssue false

Comparison of self-expandable and balloon-expanding stents for hybrid ductal stenting in hypoplastic left heart complex

Published online by Cambridge University Press:  30 August 2016

Sebastian Goreczny
Affiliation:
Department of Congenital Heart Disease, Evelina London Children’s Hospital, Guy’s and St Thomas’ NHS Foundation Trust, London, United Kingdom Department of Cardiology, Polish Mother’s Memorial Hospital, Research Institute, Lodz, Poland
Shakeel A. Qureshi
Affiliation:
Department of Congenital Heart Disease, Evelina London Children’s Hospital, Guy’s and St Thomas’ NHS Foundation Trust, London, United Kingdom
Eric Rosenthal
Affiliation:
Department of Congenital Heart Disease, Evelina London Children’s Hospital, Guy’s and St Thomas’ NHS Foundation Trust, London, United Kingdom
Thomas Krasemann
Affiliation:
Department of Congenital Heart Disease, Evelina London Children’s Hospital, Guy’s and St Thomas’ NHS Foundation Trust, London, United Kingdom
Mohamed S. Nassar
Affiliation:
Department of Congenital Heart Disease, Evelina London Children’s Hospital, Guy’s and St Thomas’ NHS Foundation Trust, London, United Kingdom
David R. Anderson
Affiliation:
Department of Congenital Heart Disease, Evelina London Children’s Hospital, Guy’s and St Thomas’ NHS Foundation Trust, London, United Kingdom
Gareth J. Morgan*
Affiliation:
Department of Congenital Heart Disease, Evelina London Children’s Hospital, Guy’s and St Thomas’ NHS Foundation Trust, London, United Kingdom
*
Correspondence to: Dr G. J. Morgan, Department of Congenital Heart Disease, St Thomas’s Hospital, Westminster Bridge Rd, London SE1 7EH, United Kingdom. Tel: +44 20 7188 4547; Fax: +44 20 7188 4546; E-mail: gareth.morgan@gstt.nhs.uk

Abstract

Objectives

We aimed to compare the procedural and mid-term performance of a specifically designed self-expanding stent with balloon-expandable stents in patients undergoing hybrid palliation for hypoplastic left heart syndrome and its variants.

Background

The lack of specifically designed stents has led to off-label use of coronary, biliary, or peripheral stents in the neonatal ductus arteriosus. Recently, a self-expanding stent, specifically designed for use in hypoplastic left heart syndrome, has become available.

Methods

We carried out a retrospective cohort comparison of 69 neonates who underwent hybrid ductal stenting with balloon-expandable and self-expanding stents from December, 2005 to July, 2014.

Results

In total, 43 balloon-expandable stents were implanted in 41 neonates and more recently 47 self-expanding stents in 28 neonates. In the balloon-expandable stents group, stent-related complications occurred in nine patients (22%), compared with one patient in the self-expanding stent group (4%). During follow-up, percutaneous re-intervention related to the ductal stent was performed in five patients (17%) in the balloon-expandable stent group and seven patients (28%) in self-expanding stents group.

Conclusions

Hybrid ductal stenting with self-expanding stents produced favourable results when compared with the results obtained with balloon-expandable stents. Immediate additional interventions and follow-up re-interventions were similar in both groups with complications more common in those with balloon-expandable stents.

Type
Original Articles
Copyright
© Cambridge University Press 2016 

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

1. Gibbs, JL, Wren, C, Watterson, KG, Hunter, S, Hamilton, JR. Stenting of the arterial duct combined with banding of the pulmonary arteries and atrial septectomy or septostomy: a new approach to palliation for the hypoplastic left heart syndrome. Br Heart J 1993; 69: 551555.Google Scholar
2. Gibbs, JL, Uzun, O, Blackburn, ME, Wren, C, Hamilton, JR, Watterson, KG. Fate of the stented arterial duct. Circulation 1999; 99: 26212625.CrossRefGoogle ScholarPubMed
3. Akintuerk, H, Michel-Behnke, I, Valeske, K, et al. Stenting of the arterial duct and banding of pulmonary arteries: basis for combined Norwood stage I and II repair in hypoplastic left heart. Circulation 2002; 105: 10991103.Google Scholar
4. Michel-Behnke, I, Akintuerk, H, Marquardt, I, et al. Stenting of the ductus arteriosus and banding of the pulmonary arteries: basis for various surgical strategies in newborns with multiple left heart obstructive lesions. Heart. 2003; 89: 645650.Google Scholar
5. Galantowicz, M, Cheatham, JP. Lessons learned from the development of a new hybrid strategy for the management of hypoplastic left heart syndrome. Pediatr Cardiol. 2005; 26: 190199.CrossRefGoogle ScholarPubMed
6. Akinturk, H, Michel-Behnke, I, Valeske, K, et al. Hybrid transcatheter-surgical palliation: basis for univentricular or biventricular repair: the Giessen experience. Pediatr Cardiol 2007; 28: 7987.CrossRefGoogle ScholarPubMed
7. Caldarone, CA, Benson, L, Holtby, H, Li, J, Redington, AN, Van Arsdell, GS. Initial experience with hybrid palliation for neonates with single-ventricle physiology. Ann Thorac Surg 2007; 84: 12941300.CrossRefGoogle ScholarPubMed
8. Galantowicz, M, Cheatham, JP, Phillips, A, et al. Hybrid approach for hypoplastic left heart syndrome: intermediate results after the learning curve. Ann Thorac Surg 2008; 85: 20632070.Google Scholar
9. Honjo, O, Benson, LN, Mewhort, HE, et al. Clinical outcomes, program evolution, and pulmonary artery growth in single ventricle palliation using hybrid and Norwood palliative strategies. Ann Thorac Surg 2009; 87: 18851893.Google Scholar
10. Venugopal, PS, Luna, KP, Anderson, DR, et al. Hybrid procedure as an alternative to surgical palliation of high-risk infants with hypoplastic left heart syndrome and its variants. J Thorac Cardiovasc Surg. 2010; 139: 12111215.Google Scholar
11. Moszura, T, Dryzek, P, Goreczny, S, et al. A 10-year single-centre experience in percutaneous interventions for multi-stage treatment of hypoplastic left heart syndrome. Cardiol Young 2014; 24: 5463.CrossRefGoogle ScholarPubMed
12. Baba, K, Chaturvedi, R, Lee, KJ, Caldarone, CA, Benson, LN. Fate of the ductal stent after hybrid palliation for hypoplastic left heart syndrome. Ann Thorac Surg 2013; 95: 16601664.CrossRefGoogle ScholarPubMed
13. Lloyd, DF, Cutler, L, Tibby, SM, et al. Analysis of preoperative condition and interstage mortality in Norwood and hybrid procedures for hypoplastic left heart syndrome using the Aristotle scoring system. Heart 2014; 100: 775780.Google Scholar
14. Schranz, D, Bauer, A, Reich, B, et al. Fifteen-year single center experience with the “Giessen Hybrid” approach for hypoplastic left heart and variants: current strategies and outcomes. Pediatr Cardiol 2015; 36: 365373.Google Scholar
15. Rolland, PH, Charifi, AB, Verrier, C, et al. Hemodynamics and wall mechanics after stent placement in swine iliac arteries: comparative results from six stent designs. Radiology 1999; 213: 229246.Google Scholar
16. Stoeckel, D, Pelton, A, Duerig, T. Self-expanding nitinol stents: material and design considerations. Eur Radiol 2004; 14: 292301.Google Scholar
17. Grenacher, L, Rohde, S, Gänger, E, Deutsch, J, Kauffmann, GW, Richter, GM. In vitro comparison of self-expanding versus balloon-expandable stents in a human ex vivo model. Cardiovasc Intervent Radiol 2006; 29: 249254.Google Scholar
18. Goreczny, S, Qureshi, S, Rosenthal, E, et al. Self-expanding stent implantation in arterial duct during hybrid palliation of hypoplastic left heart syndrome: midterm experience with a specially designed stent. EuroIntervention 2015; 10: 13181325.CrossRefGoogle ScholarPubMed
19. Schranz, D, Michel-Behnke, I. Advances in interventional and hybrid therapy in neonatal congenital heart disease. Semin Fetal Neonatal Med 2013; 18: 311321.CrossRefGoogle ScholarPubMed
20. Schneider, M, Zartner, P, Sidiropoulos, A, Konertz, W, Hausdorf, G. Stent implantation of the arterial duct in newborns with duct-dependent circulation. Eur Heart J 1998; 19: 14011409.Google Scholar
21. Santoro, G, Palladino, MT, Capozzi, G, Iacono, C, Russo, MG, Calabrò, R. Pulmonary artery growth following arterial duct stenting in congenital heart disease with duct-dependent pulmonary circulation. Catheter Cardiovasc Interv 2009; 74: 10721076.CrossRefGoogle ScholarPubMed
22. Santoro, G, Gaio, G, Giugno, L, et al. Ten-years, single-center experience with arterial duct stenting in duct-dependent pulmonary circulation: early results, learning-curve changes, and mid-term outcome. Catheter Cardiovasc Interv 2015; 86: 249257.Google Scholar
23. Ballard, G, Tibby, S, Miller, O, et al. Growth of left heart structures following the hybrid procedure for borderline hypoplastic left heart. Eur J Echocardiogr 2010; 11: 870874.Google Scholar
24. Bellsham-Revell, HR, Tibby, SM, Bell, AJ, et al. Serial magnetic resonance imaging in hypoplastic left heart syndrome gives valuable insight into ventricular and vascular adaptation. J Am Coll Cardiol 2013; 61: 561570.CrossRefGoogle ScholarPubMed
25. Bell, A, Rawlins, D, Bellsham-Revell, H, Miller, O, Razavi, R, Simpson, J. Assessment of right ventricular volumes in hypoplastic left heart syndrome by real-time three-dimensional echocardiography: comparison with cardiac magnetic resonance imaging. Eur Heart J Cardiovasc Imaging 2014; 15: 257266.CrossRefGoogle ScholarPubMed
26. Nassar, MS, Bertaud, S, Goreczny, S, et al. Technical and anatomical factors affecting the size of the branch pulmonary arteries following first-stage Norwood palliation for hypoplastic left heart syndrome. Interact Cardiovasc Thorac Surg 2015; 20: 631635.Google Scholar
27. Nassar, MS, Narayan, SA, Nyman, A, et al. Second stage after initial hybrid palliation for hypoplastic left heart syndrome: arterial or venous shunt? J Thorac Cardiovasc Surg. 2015; 150: 350357.Google Scholar