Premium
Stenting of the inter‐atrial septum in infants and small children: Indications, techniques and outcomes
Author(s) -
Mainzer Gur,
Goreczny Sebastian,
Morgan Gareth J.,
Qureshi Shakeel,
Krasemann Thomas,
Dryzek Pawel,
Moll Jadwiga A,
Moszura Tomasz,
Rosenthal Eric
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.27462
Subject(s) - medicine , stent , surgery , balloon dilation , adverse effect , balloon , angioplasty , hemodynamics , retrospective cohort study , cardiology
Objectives To evaluate the procedural success and outcome of inter‐atrial stenting. Background Inter‐atrial stenting has been shown to be an effective way to maintain inter‐atrial blood flow, however it is considered a high risk procedure, usually performed urgently in patients with significant hemodynamic compromise. Methods Between September 2004 and August 2016, inter‐atrial stenting was attempted in 29 children. Procedural, clinical, and follow‐up data were collected retrospectively. Results The procedures were completed successfully in 27 patients. Twenty‐five procedures were undertaken percutaneously, with the remaining four being performed as hybrid procedures. The patients were considered as high risk for adverse events (82% scored as CRISP 4 and 5) with four deaths during the first 24 hr (14%). Procedural complications occurred in eight patients (28%) with related death in three patients (10%). One further patient died after an uncomplicated technically successful stent implantation performed as a salvage procedure. Procedural complications (71% vs. 14%) and mortality (43% vs. 5%) were higher in those, who weighed 3 kg or less ( P < 0.05). Patency of the stents was maintained until planned staged surgery in 22 patients at a mean of 302 days. Three patients underwent further balloon dilation for flow restriction at 58–201 days. In two un‐operated patients the stents remained patent at follow‐up. One patient with severe pulmonary hypertension died with a patent stent. Conclusions Inter‐atrial stenting produces reliable patency with a very good success rate. Morbidity and mortality were related to low weight at the time of the procedure.