“Intraoperative hybrid stenting of recurrent coarctation and arch hypoplasia with large stents in patients with univentricular hearts”

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• 作者：Nikolaus A. Haas^a ; ^c ; ^{Nikolaus.Haas@med.uni-muenchen.de" class="auth_mail" title="E-mail the corresponding author} ; Christoph M. Happel^a ; Ute Blanz^b ; Kai Thorsten Laser^a ; Marinos Kantzis^a ; Deniz Kececioglu^a ; Eugen Sandica^b
• 关键词：Intraoperative stenting ; Hybrid surgery ; Large stents ; Coarctation ; Univentricular heart ; Hypoplastic left heart syndrome
• 刊名：International Journal of Cardiology
• 出版年：2016
• 出版时间：1 February 2016
• 年：2016
• 卷：204
• 期：Complete
• 页码：156-163
• 全文大小：943 K

文摘

Obstruction of the reconstructed aortic arch, tubular hypoplasia and recurrent coarctation (RC) is an important risk factor in univentricular physiology. For the past two years we have adopted the concept of intraoperative hybrid stenting of RC and arch hypoplasia with large stents in patients with univentricular hearts as standard care procedure.

Method/Result

Retrospective analysis of the anatomy and procedural outcome of 14 patients was scheduled for intraoperative stenting of the aortic arch (12 during surgery for BCPS, 2 during Fontan completion). The median age was 5.3 months, weight 5.5 kg, height 62 cm. Five patients had tubular hypoplasia and 9 patients had distal stenosis of the aortic arch. Nine patients had a previous balloon dilatation. The mean diameter of the distal arch was 11.0 mm, at the coarctation 5.1 mm, at the level of the diaphragm 8.2 mm (CoA-index 0.62). Intraoperative stenting was performed in 13/14 patients. Stents were implanted with a mean balloon diameter of 10.8 mm (SD 3.4 mm). The achieved final mean diameter was 9.8 mm (mean, SD 2.8 mm) with an oversized Coa-index of 1.2. There was no re-coarctation at a mean follow-up of 7.3 months (range 3 to 24), the maximum flow velocity of 2 m/s across the stented lesion assessed by ECHO.

Conclusion

This hybrid approach is an easy and safe concept to manage recurrent aortic arch hypoplasia and stenosis. The use of large stents allows redilatation to adult size diameters later on.