Long‐term outcome of percutaneous intervention for pulmonary vein stenosis after pulmonary vein isolation procedure

Abstract

Objectives Report long‐term outcomes of percutaneous intervention in patients with pulmonary vein stenosis (PVS) after pulmonary vein isolation (PVI) from a single center over 16 years. Background Outcome reports of percutaneous intervention for PVS resulting from PVI are limited. Methods Retrospective review of all patients with PVS after PVI who underwent percutaneous intervention at the Cleveland Clinic Foundation between January 2000 and December 2016. Results A total of 205 patients underwent cardiac catheterization for PVS during the study period. Completely occluded veins which could not be recanalized occurred in six patients. Of the remaining 199 patients, 27 (14%) were lost to follow‐up, leaving 172 patients with 276 veins for analysis. Balloon angioplasty was performed in 62 veins and stent implantation in 250 (primary in 214, to treat postdilation restenosis in 36). Re‐intervention occurred in 45/62 (73%) balloon‐dilated veins and 45/250 (18%) stented veins. Freedom from re‐intervention at 1 and 5 years was 90 and 73% following stenting versus 40 and 23% following balloon dilation (p < .001, Hazard ratio (HR) = 5.7). Veins with stent diameter ≥7 mm (n = 231) had greater freedom from re‐intervention (95% at 1 year, 79% at 5 years) than veins with stents <7 mm (43% at 1 year, 9% at 5 years), p < .001. There was clear symptomatic improvement after intervention and no procedural mortality. Conclusions Stent implantation at ≥7 mm for PVS after PVI is associated with low rates of re‐intervention, in contrast to balloon dilation and stenting with small conventional stents.

Pulmonary Vein Intervention for Severe Pulmonary Vein Stenosis After Atrial Fibrillation Ablation ― A Retrospective Cohort Study ―

“…Whether using a stent or balloon dilation, the diameter of the device is reported to be an important factor in longterm patency. 21,29 Our cohort data also showed a trend towards lower restenosis rates in patients with devices ≥7 mm in diameter and in patients with a BMS or DCB. However, it should be kept in mind that it is not clear whether this result is due to the choice of larger-diameter devices or BMS, or because originally larger vessels have a better outcome.…”

Pulmonary Vein Stenosis: A Review

“…[3] Larger stents appear to reduce the rate of reintervention compared with small stents and BA. [112] For restenosis, a reintervention with high-pressure ballooning, cutting balloon, and stent-in-stent is often needed. Procedure-related complications should also be considered.…”

“…Procedure-related complications should also be considered. For PVI-PVS, in a single-center and retrospective study, Suntharos et al [112] have reviewed a total of 205 patients who underwent cardiac catheterization for PVS during 2000 to 2016 and reported overall complications of 9.5% and severe complications of 4.5%, including cardiac arrest, pulmonary vein tear, and stroke. Furthermore, Duan et al [55] have shown a high incidence of procedure-related lung injury (44%) in FM-PVS.…”

Incidence and Predictors of In-stent Restenosis Following Intervention for Pulmonary Vein Stenosis due to Fibrosing Mediastinitis

“…PVS-FM is attributed to extraluminal proliferative fibrous tissue compression, [12] while other PVS are attributed to intimal hyperplasia. [13,14] Hence, even though PTPV has been successfully used in PVS-PVI, PTPV in PVS-FM might be different. Our preliminary data showed that patients with PVS-FM who underwent interventions, both in terms of hemodynamics and exercise capacity, had clinical improvement but a high prevalence of restenosis during a very short-term follow-up.…”