Cutting balloon angioplasty on branch pulmonary artery stenosis in pediatric patients

Abstract

Objectives: To identify medium-term results following cutting balloon angioplasty (CBA) for branch pulmonary artery stenosis (PAS) and predictors of successful intervention.Background: CBA has emerged as a successful alternative therapy for PAS resistant to conventional balloon angioplasty techniques but there is little information on medium and long-term outcomes.Methods: This is a descriptive, single center, retrospective chart review of pediatric patients who underwent CBA for PAS at Arkansas Children's Hospital between May 2005 and December 2020. We reviewed demographics, procedural specifics, and 30-day complications.Results: Forty-four patients underwent pulmonary artery CBA on 114 pulmonary artery segments through 126 catheterization cases, totaling 148 CBA events. Thirtythree individual pulmonary arteries underwent repeat intervention. Average minimal luminal diameter increase from pre-CBA to end of follow-up was 57% (CI, 38%-75%). Absence of Tetralogy of Fallot with pulmonary atresia and major aortopulmonary collateral arteries (TOF/PA/MAPCAs) and the absence of Alagille Syndrome, Williams Syndrome, or Arterial Tortuosity Syndrome (ATS) were associated with increased odds of sustained success by 70% (CI, 0.11-0.79) and 91% (CI, 0.02-0.56), respectively. Increasing the cutting balloon diameter-to-minimal luminal diameter ratio by 0.5 increased odds of successful intervention by 2.37-fold (CI, 1.7-3.3). Seven patients had 30-day complications including one death.Conclusions: In the longest follow-up to date of children and adolescents who underwent CBA for branch PAS, we found that there was moderate medium-term success.Additionally, absence of TOF/PA/MAPCAs, absence of Alagille Syndrome, Williams Syndrome, or ATS, and high cutting balloon diameter-to-minimal luminal diameter ratio are predictors of sustained results.

Virtual Transcatheter Interventions for Peripheral Pulmonary Artery Stenosis in Williams and Alagille Syndromes

“…WS and AS, however, have been associated with significantly worse odds for sustained increases in intraluminal diameters following transcatheter therapy. 4 , 7 …”

“…Surgical, transcatheter, or hybrid approaches addressing only the most proximal central PAs thus remain the standard of care at most centers despite suboptimal clinical and procedural outcomes, including significant residual disease, persistent RV hypertension, pulmonary hemorrhage, vessel dissection, aneurysm formation, PA rupture, in‐stent restenosis, and even death. 3 , 4 , 5 , 6 , 7 Given these unfavorable results and the technical challenges associated with surgical PA reconstruction, there is a pressing need to better understand the hemodynamics associated with various transcatheter approaches and to further develop a virtual treatment planning platform to identify lesions most critical for optimizing RV afterload/pulmonary vascular resistance (PVR; at the macro level) and thus PA and RV pressures.…”

Ultra-high pressure balloon angioplasty for pulmonary artery stenosis in children with congenital heart defects: Short- to mid-term follow-up results from a retrospective cohort in a single tertiary center

“…Cutting BA is effective in increasing lumen diameter, especially in lesions located distally ( 6 , 9 , 11 ). However, the relatively high restenosis rate ( 9 , 11 , 19 ) limits its widespread use. Percutaneous transluminal pulmonary artery stenting is a technically more successful procedure ( 3 , 16 , 17 , 20 – 22 ) with sustained hemodynamic improvement ( 23 ) and low restenosis rates ( 24 ), as well as fewer procedural adverse events ( 21 , 24 – 27 ).…”