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, Mohammad; Nasef, Mohamed Al; Mehta, Chetan; Botha, Phil; McMahon, Colin J.; Oslizlok, Paul; Walsh, Kevin; McCrossan, Brian; Kenny, Damien; Stümper, Oliver

doi:10.1002/ccd.29306

Cited by 7 publications

(3 citation statements)

References 20 publications

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“…An overview of the RVOT stenting strategy used at Birmingham Children's Hospital was previously published (14). Numerous cases of RVOT stenting in symptomatic patients with Tetralogy of Fallot have been reported (10,(16)(17)(18)(19). These reports demonstrate favorable procedural outcomes with low complication rates, and definitive surgical repair have not been impacted by the short-term RVOT stenting.…”

Section: Discussionmentioning

confidence: 99%

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Right ventricular outflow tract stenting promotes pulmonary artery development in tetralogy of fallot

Guo

Wu²,

Zhao³

et al. 2023

Front. Surg.

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BackgroundRight ventricular outflow tract (RVOT) stenting seems to be suggested as a promising treatment option and an alternative to modified Blalock-Taussig shunt (mBTS) in the initial palliation of patients with Fallot-type lesions in recent years. This study sought to assess the effect of RVOT stenting on the growth of the pulmonary artery (PA) in patients with Tetralogy of Fallot (TOF).MethodsRetrospective review analyzing 5 patients with Fallot-type congenital heart disease with small pulmonary arteries who underwent palliative with RVOT stenting and 9 patients underwent modified Blalock-Taussig shunt within 9 years period. Differential left PA (LPA) and right PA (RPA) growth was measured by Cardiovascular Computed Tomography Angiography (CTA).ResultsRVOT stenting improved arterial oxygen saturation from median of 60% (interquartile range [IQR]: 37% to 79%) to 95% (87.5% to 97.5%) (p = 0.028). The LPA diameter Z-score improved from −2.843 (−3.51–2.037) to −0.78 (−2.3305–0.19) (p = 0.03), the RPA diameter Z-score improved from median −2.843 (−3.51–2.037) to −0.477 (−1.1145–0.459) (p = 0.002), the Mc Goon ratio increased from median 1 (0.8–1.105) to 1.32 (1.25–1.98) (p = 0.017). There were no procedural complications and all 5 patients have undergone final repair in the RVOT stent group. In the mBTS group, the LPA diameter Z-score improved from −1.494 (−2.242–0.6135) to −0.396 (−1.488–1.228) (p = 0.15), the RPA diameter Z-score improved from median −1.328 (−2.036–0.838) to 0.088 (−0.486–1.223) (p = 0.007), and there were 5 patients occur different complications and 4 patients was not attained the standards of final surgical repair.ConclusionRVOT stenting, compared with mBTS, seems to better promote pulmonary artery growth, improve arterial oxygen saturations, and have less procedure complications in patients with TOF who being absolute contraindicated for primary repair due to high risks.

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Section: Discussionmentioning

confidence: 99%

“…Two-stage surgical therapy with growth of pulmonary artery was suggested as an appropriate option (8)(9)(10)(11). The indicators for twostage repair and primary palliation were active cyanosis, low body weight and pulmonary arteries of small size (Mc Goon ratio <1.2 (4).…”

Section: Introductionmentioning

confidence: 99%

Right ventricular outflow tract stenting promotes pulmonary artery development in tetralogy of fallot

Guo

Wu²,

Zhao³

et al. 2023

Front. Surg.

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“…Finally, RVOT stenting has also been described in the case of very complex anatomic settings associated with infundibular/pulmonary valve atresia. In this case, a hybrid approach, by trans-ventricular balloon dilation and stenting of the RVOT under direct vision through medial sternotomy, appears as a safe and well-tolerated procedure [29,30]. Moreover, in TOF and associated atrioventricular septal defects, RVOT stenting is a safe and effective palliative option [29], promoting pulmonary arterial growth and improving oxygen saturations before surgical repair.…”

Section: Introduction-historical Perspectivementioning

confidence: 92%

Right Ventricular Outflow Tract Stenting as Palliation of Critical Tetralogy of Fallot: Techniques and Results

Pizzuto

Cuman

Assanta

et al. 2021

Hearts

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Background. Despite current trends toward early primary repair, the surgical systemic-to-pulmonary shunt is still considered the first-choice palliation in patients with critical tetralogy of Fallot (TOF) and duct-dependent pulmonary circulation unsuitable for primary repair. However, stenting of the right ventricular outflow tract (RVOT) is nowadays emerging as an effective alternative to surgical palliation in selected patients. Methods and results. RVOT stenting is usually performed from a venous route, either femoral or, in selected cases, the right internal jugular vein. Less frequently, mostly in pulmonary infundibular/valvar atresia, this procedure can be performed using a hybrid surgical/interventional approach by surgical exposure of the RVOT, puncture of the atretic valve, and stent deployment under direct vision. The size and type of the most appropriate stent may be chosen, based on ultrasound measurements of the RVOT, to cover the right ventricular infundibulum completely and, at the same time, sparing the pulmonary valve, unless significant pulmonary valve annulus hypoplasia and/or supra-valvular stenosis is a significant component of the obstruction. In the large series so far published, early mortality of RVOT stenting is less than 2%, comparing favourably with either Blalock-Thomas-Taussig shunt or early primary repair. In addition, morbidity and clinical sequelae of this approach do not significantly differ from surgical palliation, even if RVOT stenting shows lesser durability and a higher rate of trans-catheter re-interventions over a mid-term follow-up. Finally, similar but more balanced pulmonary artery growth than surgical palliation following RVOT stenting is reported over a mid-term follow-up. Conclusions. RVOT stenting is a technically feasible, well-tolerated, and effective palliation in critical TOF. This approach is cost-effective with respect to surgical palliation either in high-risk neonates or whenever a short-term pulmonary blood flow source is anticipated due to the early surgical repair. It effectively increases pulmonary blood flow, improves arterial saturation, and promotes balanced pulmonary artery growth over a mid-term follow-up.

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Contemporary surgical management of complete atrioventricular septal defect with tetralogy of Fallot in Japan

Sugimoto

Tachimori

Hirata

et al. 2022

Gen Thorac Cardiovasc Surg

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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

Cited by 7 publications

References 20 publications

Right ventricular outflow tract stenting promotes pulmonary artery development in tetralogy of fallot

Right ventricular outflow tract stenting promotes pulmonary artery development in tetralogy of fallot

Right Ventricular Outflow Tract Stenting as Palliation of Critical Tetralogy of Fallot: Techniques and Results

Contemporary surgical management of complete atrioventricular septal defect with tetralogy of Fallot in Japan

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