Right ventricular outflow tract stent versus BT shunt palliation in Tetralogy of Fallot

Quandt, Daniel; Ramchandani, Bharat; Penford, Gemma; Stickley, John; Bhole, Vinay; Mehta, Chetan; Jones, Timothy J.; Barron, David J.; Stümper, Oliver

doi:10.1136/heartjnl-2016-310620

Cited by 38 publications

(56 citation statements)

References 17 publications

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“…Complications associated with interventional procedures are related to pre-exis- for RVOT stenting compared to 4.9% for modified Blalock-Taussig shunt. 44,45 The major complications related to this procedure are perforation of the RVOT and hemopericardium, damage of the tricuspid valve apparatus, stent dislodgement into the right ventricle, stent embolization into the aortic arch followed by moderate to severe aortic valve regurgitation, or stent thrombosis. [44][45][46][47][48][49][50][51][52][53]…”

Section: Results and Complicationsmentioning

confidence: 99%

Interventional Treatment of Cardiac Emergencies in Children with Congenital Heart Diseases

Cinteză

Nicolescu

Filip

et al. 2019

Journal of Cardiovascular Emergencies

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Cardiac emergencies in children represent an extremely important issue in medical practice. In general, interventional treatment could be optional in many situations, however it can be indicated in emergency conditions. There are many diseases at pediatric age that can benefit from interventional treatment, thus reducing the surgical risks and subsequent complications. Balloon atrioseptostomy, patent ductus arteriosus (PDA) closure, percutaneous or hybrid closure of a ventricular septal defect, pulmonary or aortic valvuloplasty, balloon angioplasty for aortic coarctation, implantation of a stent for coarctation of the aorta, for severe stenosis of the infundibulum of the right ventricle, or for PDA correction are among the procedures that can be performed in emergency situations. This review aims to present the current state of the art in the field of pediatric interventional cardiology.

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Section: Results and Complicationsmentioning

confidence: 99%

Interventional Treatment of Cardiac Emergencies in Children with Congenital Heart Diseases

Cinteză

Nicolescu

Filip

et al. 2019

Journal of Cardiovascular Emergencies

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“…Procedure‐related complications were reported as perforation of the PA or RVOT leading to hemothorax and pericardial effusion, valvular regurgitation (tricuspid) and stent emboli. The rate of catheter reintervention was 37.5% (27/72) . In comparison to the group with BT shunt palliation, the RVOT stent group had a shorter time to surgical repair (232 days vs 428 days), lower intensive care admission rate (22% vs 100%) and shorter length of stay (median 7 days vs 14 days) .…”

Section: Rvot Stenting In Patients With Tofmentioning

confidence: 93%

“…The rate of catheter reintervention was 37.5% (27/72) . In comparison to the group with BT shunt palliation, the RVOT stent group had a shorter time to surgical repair (232 days vs 428 days), lower intensive care admission rate (22% vs 100%) and shorter length of stay (median 7 days vs 14 days) . Older patients with repaired TOF may also present with residual RVOT stenosis amenable to catheter balloon dilation and possibly stent implantation .…”

Section: Rvot Stenting In Patients With Tofmentioning

confidence: 96%

“…The rate of catheter reintervention was 37.5% (27/ 72). 52 In comparison to the group with BT shunt palliation, the DAABOUL ET AL.…”

Section: Initial Attempts At Nonsurgical Interventions With Balloon Vmentioning

confidence: 98%

“…RVOT stent group had a shorter time to surgical repair (232 days vs 428 days), lower intensive care admission rate (22% vs 100%) and shorter length of stay (median 7 days vs 14 days). 52 Older patients with repaired TOF may also present with residual RVOT stenosis amenable to catheter balloon dilation and possibly stent implantation. 53 The first attempt at transcatheter pulmonary valvotomy in PA/ IVS was described by Qureshi in 1990, with a success rate at shortterm follow-up in four of the five cases.…”

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confidence: 99%

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Anesthesia for high‐risk procedures in the catheterization laboratory

Daaboul

DiNardo

Nasr

2019

Pediatric Anesthesia

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Summary Recent advances in catheterization and imaging technology allow for more complex procedures to be performed in the catheterization laboratory. A number of lesions are now amenable to a percutaneous procedure, eliminating or at least postponing the need for a surgical intervention. Due to the increase in the complexity of the procedures performed, the involvement of anesthesiologists and their close collaboration with the interventional cardiologists have increased. It is important to understand the physiology and pathophysiology of the patients and to anticipate the plans and the potential complications in order to manage them. We are witnessing a rise in the number of complex interventions in newborns and infants, such as balloon valvotomy (critical aortic stenosis, pulmonary stenosis), radio frequency perforation (of pulmonary atresia and intact ventricular septum), right ventricular outflow tract stenting (in Tetralogy of Fallot), ductal stenting (in some ductus‐dependent pulmonary circulation), and combined with a surgical procedure (hybrid procedure for hypoplastic left heart syndrome). Multiple registries have been created in order to understand and improve outcomes of patients with congenital heart disease undergoing catheterization procedures and to develop performance and quality metrics, from which data regarding anesthetic‐related risks can be extrapolated. Experienced personnel and a multidisciplinary team approach with direct communication among the team members is a must to ensure anticipation and management of critical events when they occur.

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Short to medium term outcomes of right ventricular outflow tract stenting as initial palliation for symptomatic infants with complete atrioventricular septal defect with associated tetralogy of Fallot

Abumehdi

Nasef

Mehta

et al. 2020

Cathet Cardio Intervent

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Objectives: To assess the impact of right ventricular outflow tract (RVOT) stenting as the primary palliation in infants with complete atrioventricular septal defect with associated tetralogy of Fallot (cAVSD/TOF). Background: Historically, palliation of symptomatic patients with cAVSD/TOF has been achieved through surgical systemic to pulmonary artery shunting. More recently RVOT stenting has evolved as an acceptable alternative in patients with tetralogy of Fallot. Methods: Retrospective review of all patients with cAVSD/TOF who underwent RVOT stenting as palliation over a 13-year period from two large tertiary referral centers. Results: Twenty-six patients underwent RVOT stenting at a median age of 57 days (interquartile range [IQR] 25.5-106.5). Median weight for stent deployment was 3.7 kg (IQR 2.91-5.5 kg). RVOT stenting improved oxygen saturations from a median of 72% (IQR 70-76%) to 90% (IQR 84-92%), p < .001. There was a significant increase in the median Z-score for both branch pulmonary arteries at median follow-up of 255 days (IQR 60-455). Eight patients required RVOT stent balloon dilatations and 8 patients required re-stenting for progressive desaturation. The median duration between reinterventions was 122 days (IQR 53-294 days). Four patients died during the follow-up period. No deaths resulted from the initial intervention. To date, definitive surgical intervention was achieved in 19 patients (biventricular repair n = 15) at a median age of 369 days (IQR 223-546 days).

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Right ventricular outflow tract stent versus BT shunt palliation in Tetralogy of Fallot

Abstract: RVOT stenting in Fallot-type lesions can be accomplished safely, with lower PICU admission rate, a shorter hospital length of stay and shorter duration of palliation until complete repair compared with mBTS palliation.

Cited by 38 publications

References 17 publications

Interventional Treatment of Cardiac Emergencies in Children with Congenital Heart Diseases

Interventional Treatment of Cardiac Emergencies in Children with Congenital Heart Diseases

Anesthesia for high‐risk procedures in the catheterization laboratory

Short to medium term outcomes of right ventricular outflow tract stenting as initial palliation for symptomatic infants with complete atrioventricular septal defect with associated tetralogy of Fallot

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