Pulmonary artery stents: Long-term follow-up

Mark A. Law, Pirouz Shamszad, Alan W. Nugent, Henri Justino, John P. Breinholt, Charles E. Mullins, Frank Ing

Research output: Contribution to journalArticle

59 Citations (Scopus)

Abstract

Objectives: Determine the long-term outcomes of branch pulmonary artery (PA) stents. Background: PA stents in congenital heart disease effectively relieve stenoses in the short-term. Published long-term data are limited. Methods: Patients enrolled in an FDA IDE protocol from 1989-92 were included. Clinical follow-up and catheterization data were evaluated. Patients were included if >5 year follow-up data was available or if mortality occurred following the initial procedure. Results: There were five deaths: four due to progression of their underlying heart disease, and one from a complication during a follow-up catheterization. Clinical data for 43 surviving patients demonstrated 39 patients (91%) are in NYHA class I or II. Seven patients underwent surgical intervention during the follow-up period (five RV-PA conduit, two Fontan revisions), but none addressed PA stenosis. Final repeat catheterizations were performed in 36 patients (55 stents) 7.2 ± 4.3 years post stent insertion with 1.2 ± 0.9 further procedures with stent dilations. In this subgroup, the minimum vessel diameter increased from 4.7 ± 1.8 to 13.4 ± 2.4 mm (P < 0.001), and the pressure gradient improved from 41 ± 25 to 9 ± 11 mm Hg (P < 0.001). Higher initial gradient and smaller balloons were associated with a final stent diameter of <14 mm (P = 0.030 and 0.046). Jailed vessels occurred in 49% of stents with abnormal angiographic flow in 18/55. Six repeat catheterizations resulted in complications, including the one procedural death. Conclusion: Stents implants for PA stenoses provide effective improvement in vessel caliber in the long-term. Although repeat interventions are necessary, this procedure reduces RV pressure and provides an important alternative to surgery for residual PA obstruction.

Original languageEnglish (US)
Pages (from-to)757-764
Number of pages8
JournalCatheterization and Cardiovascular Interventions
Volume75
Issue number5
DOIs
StatePublished - Apr 1 2010
Externally publishedYes

Fingerprint

Pulmonary Artery
Stents
Catheterization
Heart Diseases
Pressure
Dilatation
Pathologic Constriction
Mortality

Keywords

  • Congenital heart disease
  • Pediatric intervention
  • Right ventricle

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Radiology Nuclear Medicine and imaging

Cite this

Law, M. A., Shamszad, P., Nugent, A. W., Justino, H., Breinholt, J. P., Mullins, C. E., & Ing, F. (2010). Pulmonary artery stents: Long-term follow-up. Catheterization and Cardiovascular Interventions, 75(5), 757-764. https://doi.org/10.1002/ccd.22356

Pulmonary artery stents : Long-term follow-up. / Law, Mark A.; Shamszad, Pirouz; Nugent, Alan W.; Justino, Henri; Breinholt, John P.; Mullins, Charles E.; Ing, Frank.

In: Catheterization and Cardiovascular Interventions, Vol. 75, No. 5, 01.04.2010, p. 757-764.

Research output: Contribution to journalArticle

Law, MA, Shamszad, P, Nugent, AW, Justino, H, Breinholt, JP, Mullins, CE & Ing, F 2010, 'Pulmonary artery stents: Long-term follow-up', Catheterization and Cardiovascular Interventions, vol. 75, no. 5, pp. 757-764. https://doi.org/10.1002/ccd.22356
Law MA, Shamszad P, Nugent AW, Justino H, Breinholt JP, Mullins CE et al. Pulmonary artery stents: Long-term follow-up. Catheterization and Cardiovascular Interventions. 2010 Apr 1;75(5):757-764. https://doi.org/10.1002/ccd.22356
Law, Mark A. ; Shamszad, Pirouz ; Nugent, Alan W. ; Justino, Henri ; Breinholt, John P. ; Mullins, Charles E. ; Ing, Frank. / Pulmonary artery stents : Long-term follow-up. In: Catheterization and Cardiovascular Interventions. 2010 ; Vol. 75, No. 5. pp. 757-764.
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abstract = "Objectives: Determine the long-term outcomes of branch pulmonary artery (PA) stents. Background: PA stents in congenital heart disease effectively relieve stenoses in the short-term. Published long-term data are limited. Methods: Patients enrolled in an FDA IDE protocol from 1989-92 were included. Clinical follow-up and catheterization data were evaluated. Patients were included if >5 year follow-up data was available or if mortality occurred following the initial procedure. Results: There were five deaths: four due to progression of their underlying heart disease, and one from a complication during a follow-up catheterization. Clinical data for 43 surviving patients demonstrated 39 patients (91{\%}) are in NYHA class I or II. Seven patients underwent surgical intervention during the follow-up period (five RV-PA conduit, two Fontan revisions), but none addressed PA stenosis. Final repeat catheterizations were performed in 36 patients (55 stents) 7.2 ± 4.3 years post stent insertion with 1.2 ± 0.9 further procedures with stent dilations. In this subgroup, the minimum vessel diameter increased from 4.7 ± 1.8 to 13.4 ± 2.4 mm (P < 0.001), and the pressure gradient improved from 41 ± 25 to 9 ± 11 mm Hg (P < 0.001). Higher initial gradient and smaller balloons were associated with a final stent diameter of <14 mm (P = 0.030 and 0.046). Jailed vessels occurred in 49{\%} of stents with abnormal angiographic flow in 18/55. Six repeat catheterizations resulted in complications, including the one procedural death. Conclusion: Stents implants for PA stenoses provide effective improvement in vessel caliber in the long-term. Although repeat interventions are necessary, this procedure reduces RV pressure and provides an important alternative to surgery for residual PA obstruction.",
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