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Hybrid procedure of right ventricle outflow tract stenting in small infants with pulmonary atresia and ventricular septal defect: early and mid-term results from a single centre

Published online by Cambridge University Press:  07 February 2019

Sara Bondanza ,
Maria Grazia Calevo ,
Maria Elena Derchi ,
Francesco Santoro  and
Maurizio Marasini
Sara Bondanza*
Affiliation:
Cardio-Thoracic, Abdominal and Transplantation Department, IRCCS Istituto Giannina Gaslini, Genoa, Italy
Maria Grazia Calevo
Affiliation:
UOSD Epidemiology, Biostatistics and Committees, IRCCS Istituto Giannina Gaslini, Genoa, Italy
Maria Elena Derchi
Affiliation:
Cardio-Thoracic, Abdominal and Transplantation Department, IRCCS Istituto Giannina Gaslini, Genoa, Italy
Francesco Santoro
Affiliation:
Cardio-Thoracic, Abdominal and Transplantation Department, IRCCS Istituto Giannina Gaslini, Genoa, Italy
Maurizio Marasini
Affiliation:
Cardio-Thoracic, Abdominal and Transplantation Department, IRCCS Istituto Giannina Gaslini, Genoa, Italy
*
Author for correspondence: S. Bondanza, MD, Cardio-Thoracic, Abdominal and Transplantation Department, IRCCS Istituto Giannina Gaslini, Via Gerolamo Gaslini 5, Genoa, 16147, Italy. Tel: +3901056362333; Fax: +39010383221; E-mail: bondanzasara@gmail.com, sarabondanza@gaslini.org
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Abstract

Introduction

Pulmonary atresia, ventricular septal defect, major aorto-pulmonary collateral arteries, and pulmonary arteries hypoplasia are rare and complex congenital defects that require early interventions to relieve cyanosis and enhance the growth of native pulmonary arteries. The treatment of these patients is still controversial. Surgical techniques require cardiopulmonary bypass which is poorly tolerated by small infants. Percutaneous techniques such as radiofrequency perforation can be challenging. The hybrid technique consists of perventricular stenting of the right ventricle outflow tract through medial sternotomy, to restore native pulmonary flow.

Methods

We retrospectively reviewed the cardiovascular database of our centre in order to analyse our experience in hybrid procedure. We detected six patients who underwent hybrid first approach between November 2007 and December 2015. We report our early results and mid-term outcomes.

Results

Median age at the procedure was 26 days, median weight was 3150 g, and median Nakata index was 52 mm2/m2. All procedures were successful except for one: this patient underwent a surgical shunt. No immediate and early deaths or major complications occurred and oxygen saturation levels increased in all the patients. Patients were followed up for a period of 12–103 months, and four of them underwent a procedure of unifocalisation at the mean age of 12.5 months.

Conclusions

We reported data from the largest series of patients who underwent this hybrid procedure. Our experience demonstrated encouraging results to expand the use of this approach to bridge high-risk patients with diminutive pulmonary arteries to a second step of surgical repair.

Keywords

Multi-focal pulmonary vascularisationdiminutive native pulmonary arteriesperventricular stentingright ventricle outflow tracthybrid palliation
Type
Original Article
Information
Cardiology in the Young , Volume 29 , Issue 3 , March 2019 , pp. 375 - 379
Copyright
© Cambridge University Press 2019 

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Footnotes

Cite this article: Bondanza S, Calevo MG, Derchi ME, Santoro F, Marasini M. (2019) Hybrid procedure of right ventricle outflow tract stenting in small infants with pulmonary atresia and ventricular septal defect: early and mid-term results from a single centre. Cardiology in the Young29: 375–379. doi: 10.1017/S1047951118002482

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