Interventional cardiac catheterization procedures in pediatric cardiac transplant patients: Transplant surgery is not the end of the road

Morchi, Gira S.; Pietra, Biagio A.; Boucek, Mark M.; Chan, Kak‐Chen

doi:10.1002/ccd.21725

Cited by 13 publications

(13 citation statements)

References 39 publications

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“…Our 3.4% rate of stent implantation among OHTs is similar to the 1%‐5% rate published in other studies . Patients who required SVC stent implantation were of a younger age and smaller weight compared to those who did not require SVC stenting in our study population.…”

Section: Discussionsupporting

confidence: 87%

Transcatheter stenting of superior vena cava obstruction after pediatric heart transplantation: A single‐center experience assessing risk factors and outcomes

Salavitabar

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Torres

et al. 2018

Pediatric Transplantation

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Transcatheter stent implantation for SVC obstruction following OHT has been well described, particularly in pediatric patients. This study describes a large single-center pediatric heart transplant experience that investigates the risk factors for SVC stenosis requiring stent implantation and its associated outcomes. All pediatric OHTs between January 1, 2000, and December 12, 2016, were examined for risk factors. Twelve of 349 (3.4%) OHTs required SVC stent implantation. Patients who required stents were younger (2.5 years vs 10.0 years, P = 0.0097), weighed less (8.6 kg vs 26.0 kg, P = 0.0024), and were more likely to have had CHD (83% vs 32%, P = 0.001) or previous SCPA (58% vs 18%, P = 0.002). Bicaval anastomosis was not associated with subsequent SVC stent implantation. Symptoms included SVC syndrome and chylous effusions. All 12 patients had evidence of significant SVC obstruction by both echocardiographic Doppler interrogation and transcatheter angiography. There were no acute procedural complications; however, reinterventions were common (four of 12 patients) and occurred at a mean of 5.7 ± 3.6 months poststent implantation. In conclusion, transcatheter SVC stent implantation is safe and effective after OHT. There were significant associations between SVC stent implantation and younger age, smaller weight, CHD, and history of SCPA, but not with bicaval anastomosis or donor-recipient weight ratio.

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Section: Discussionsupporting

confidence: 87%

Transcatheter stenting of superior vena cava obstruction after pediatric heart transplantation: A single‐center experience assessing risk factors and outcomes

Salavitabar

Flyer

Torres

et al. 2018

Pediatric Transplantation

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“…[119126] Rarely, patients who have undergone orthothopic heart transplantation may present with stenosis at the site of venous anastomosis that can be successfully treated by stent therapy. [129] Baffle fenestrations in total cavopulmonary connection may be closed using covered stents,[130] especially in the presence of a baffle stenosis. [123] The stenting of central pulmonary vessels after Glenn or Fontan procedure represents a very special situation as passive flow in the pulmonary arteries depends on optimal flow conditions.…”

Section: Stenting the Aortamentioning

confidence: 99%

“…[188] For use in CHD, implantation of DES has been reported in the arterial duct feeding an isolated left PA,[189] a conduit in the RVOT of an infant,[189190] the vertical vein of a supracardiac totally anomalous pulmonary venous connection,[191] an obstructed infracardiac totally anomalous pulmonary venous connection[192] and a pulmonary vein stenosis after orthotopic heart transplantation. [129] As most of the experience with DES comes from coronary stents in adults, the efficacy and safety of these devices in CHD and for pediatric use remain unknown. However, if the mechanism of restenosis is the same in coronary arteries and other vessels, these devices may hold future options for children with CHD.…”

Section: Biodegradable Stentsmentioning

confidence: 99%

The role of stents in the treatment of congenital heart disease: Current status and future perspectives

2009

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Intravascular or intracardiac stenoses occur in many forms of congenital heart disease (CHD). Therefore, the implantation of stents has become an accepted interventional procedure for stenotic lesions in pediatric cardiology. Furthermore, stents are know to be used to exclude vessel aneurysm or to ensure patency of existing or newly created intracardiac communications. With the further refinement of the first generation of devices, a variety of “modern” stents with different design characteristics have evolved. Despite the tremendous technical improvement over the last 20 years, the “ideal stent” has not yet been developed. Therefore, the pediatric interventionalist has to decide which stent is suitable for each lesion. On this basis, currently available stents are discussed in regard to their advantages and disadvantages for common application in CHD. New concepts and designs developed to overcome some of the existing problems, like the failure of adaptation to somatic growth, are presented. Thus, in the future, biodegradable or growth stents might replace the currently used generation of stents. This might truly lead to widening indications for the use of stents in the treatment of CHD.

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“…Superior vena cava (SVC) obstruction has emerged as a notable complication following OHT, particularly with the bicaval method of graft implantation. 1–3 It has been postulated that younger age at transplantation, donor—recipient caval mismatch, 4,5 and previous surgery involving the SVC, 6 and previous superior cavopulmonary anastomosis (CPA) 7 may be risk factors for posttransplant SVC obstruction. However, the incidence of SVC obstruction in pediatric heart transplant patients and the effect of pretransplant exposure to previous superior CPA or other types of non-CPA SVC surgeries remain unknown.…”

mentioning

confidence: 99%

Frequency of Superior Vena Cava Obstruction in Pediatric Heart Transplant Recipients and Its Relation to Previous Superior Cavopulmonary Anastomosis

Aldoss¹,

Arain²,

Vinocur³

et al. 2013

The American Journal of Cardiology

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The risk factors for superior vena cava (SVC) obstruction after pediatric orthotopic heart transplantation (OHT) have not been identified. This study tested the hypothesis that pretransplant superior cavopulmonary anastomosis (CPA) predisposes patients to SVC obstruction. A retrospective review of file Pediatric Cardiac Care Consortium registry from 1982 through 2007 was performed. Previous CPA, other cardiac surgeries, gender, age at transplantation, and weight at transplantation were assessed for the risk of developing SVC obstruction. Death, subsequent OHT, or reoperation involving the SVC were treated as competing risks. Of the 894 pediatric OHT patients identified, 3.1% (n = 28) developed SVC obstruction during median follow-up of 1.0 year (range: 0 to 19.5 years). Among patients who developed SVC obstruction, 32% (n = 9) had pretransplant CPA. SVC surgery before OHT was associated with posttransplant development of SVC obstruction (p <0.001) after adjustment for gender, age, and weight at OHT and year of OHT. Patients with previous CPA had increased risk for SVC obstruction compared with patients with no history of previous cardiac surgery (hazard ratio 10.6,95% confidence interval: 3.5 to 31.7) and to patients with history of non-CPA cardiac surgery (hazard ratio 4.7,95% confidence interval: 1.8 to 12.5). In conclusion, previous CPA is a significant risk factor for the development of post—heart transplant SVC obstruction. Published by Elsevier Inc. (Am J Cardiol 2013;112:286–291)

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Interventional cardiac catheterization procedures in pediatric cardiac transplant patients: Transplant surgery is not the end of the road

Abstract: Anastomotic aortic arch and venous obstructive lesions should be sought following pediatric OHT as they occur in almost 20% of patients and can be successfully addressed using interventional techniques.

Cited by 13 publications

References 39 publications

Transcatheter stenting of superior vena cava obstruction after pediatric heart transplantation: A single‐center experience assessing risk factors and outcomes

Transcatheter stenting of superior vena cava obstruction after pediatric heart transplantation: A single‐center experience assessing risk factors and outcomes

The role of stents in the treatment of congenital heart disease: Current status and future perspectives

Frequency of Superior Vena Cava Obstruction in Pediatric Heart Transplant Recipients and Its Relation to Previous Superior Cavopulmonary Anastomosis

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