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Stenting and overdilating small Gore‐Tex vascular grafts in complex congenital heart disease
Author(s) -
Penford Gemma,
Quandt Daniel,
Mehta Chetan,
Bhole Vinay,
Dhillon Rami,
Seale Anna,
Stumper Oliver
Publication year - 2018
Publication title -
catheterization and cardiovascular interventions
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.988
H-Index - 116
eISSN - 1522-726X
pISSN - 1522-1946
DOI - 10.1002/ccd.27310
Subject(s) - medicine , stenosis , surgery , adverse effect , univariate analysis , cardiology , perioperative , pulmonary artery banding , heart disease , multivariate analysis
Background Gore‐Tex ® grafts are integral in the management of congenital heart disease. Issues of graft stenosis or somatic outgrowth may precipitate high‐risk early surgery, and catheter intervention is a relatively under‐reported management option. Objectives To assess efficacy, safety, and outcomes of stenting and overdilating small Gore‐Tex ® vascular grafts with the aim of optimizing surgical timing. Methods Retrospective analysis of single‐center, 13‐year experience of 93 graft stenting interventions or reintervention in 80 patients, with the aim of relieving stenosis ± overdilation, to depose surgical graft revision or optimize surgical timing and candidacy. Results Median preintervention graft diameter was 52% (IQR 43–63) of nominal size, postintervention this increased to median 102% (IQR 96–120) [ P < 0.001]. Overdilation was achieved in 54%; of these, the median final internal lumen was 126% (IQR 113–132) [ P < 0.001]. Mean oxygen saturations increased from 69% to 82% [ P < 0.001]. Adverse event rate was 14.9%; this includes mortality (3.2%) and atrioventricular conduction block (8.5%). Univariate analysis and logistic regression showed a significant relationship between adverse events and young age [ P < 0.01], low weight [ P < 0.01], univentricular physiology [ P < 0.001], use of femoral venous access alone [ P = 0.03], and intervention on a right ventricle to pulmonary artery conduit [ P = 0.03]. Within respective indication groups, 74% were bridged to elective cavopulmonary shunt, 95% were bridged to biventricular surgery, and 78% of long‐term palliative care patients continue under follow‐up. Conclusions Gore‐Tex ® vascular grafts can be stented effectively and expanded beyond nominal diameters by around +26%. This improves oxygen saturations, providing excellent palliation and optimized surgical timing. Adverse events are most frequent in precavopulmonary shunt patients. Condensed Abstract Gore‐Tex ® grafts are widely used in the palliation of cyanotic congenital heart disease. Grafts may become stenosed and do not allow for somatic growth. Over a 13 year period, graft stenting was performed in 80 patients (93 technically successful interventions, 4 unsuccessful.) Median internal lumen change was +50% (of nominal graft size), mean oxygen saturation change +13%. Over‐dilation was performed in more than half of the cohort, with a median gain of +26% on nominal graft size. In precavopulmonary shunt patients, there was a moderate incidence of serious complications. Clinically useful deferral of surgery was achieved for the majority.