Stenting of the right ventricular outflow tract as primary palliation for Fallot-type lesions

Abstract

Background: To describe the institutional experience, technical aspects and outcome of stenting of the right ventricular outflow tract (RVOT) in the initial palliation of symptomatic patients with severely limited pulmonary blood flow. Methods: Retrospective case note and procedure review of patients undergoing stenting of the RVOT over a 10 year period at a quarternary institution. Patients: Between 2005 and 2014, 76 selected patients underwent cardiac catheterization with the aim to implant a stent into an obstructed RVOT to improve pulmonary blood flow. Median age at stent implantation was 57 (range 4-406) days and median weight was 3.4 (1.7-12.2) kg. Results: Seventy-two patients underwent stent implantation. Median procedure time was 53 (23-260) and fluoroscopy time 14 (5.2-73) minutes. Stents were implanted through either 4 F or 6 F sheaths. Median stent diameter was 5 (4-7) mm and stent length 16 (12-24) mm. There was one procedural death (1.4%) and one emergency surgery (1.4%). Saturations increased from 70 (52-83)% to 93(81-100)% [p < 0.001]. Within 30 days, two patients required early shunts due to inadequate palliation and two died from non-cardiac causes. Conclusion: Stenting of the RVOT is an effective treatment option in the initial palliation of selected patients with very reduced pulmonary blood flow due to severe right ventricular outflow tract obstruction.

Primary repair versus surgical and transcatheter palliation in infants with tetralogy of Fallot

“…In our study more than two thirds of the RVOTd procedures did not employ a stent, which would explain the much lower proportion of transannular patching (47% before matching, 68% after matching compared with 82% reported by Wilder et al and 100% by Sandoval et al , the latter using only stenting) 5 10. Quandt et al describe a large single centre experience with RVOT stenting in a variety of lesions, transannular patch usage being comparable to SPS 12. In our study we observed that using a balloon rather than a stent increases the risk of SPS placement afterwards due to inadequate pulmonary blood flow.…”

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

“…10,16 Rates of re-intervention are not insignificant (65%) and higher than in previous studies in TOF (37.5%). 12 However, the aforementioned study contained all patients with TOF, and not only the cAVSD/TOF subset.…”

“…The cAVSD subset was identified as one of the lesions that required reintervention more frequently, as well as those of low weight, both possibly explaining the higher intervention rates in our cohort. 12 Furthermore, the weight and age of complete surgical repair is higher than in TOF alone, indicating a longer palliative period will likely lead to more reinterventions. 6 Our results are similar to that of Vitnova et al in that those who underwent a staged surgical repair were younger at the time of initial intervention and were more frequently cyanotic.…”

“…An outline of the Birmingham Children's Hospital approach to RVOT stenting has been published previously. 12 Table 2.…”

Tetralogy of Fallot: Case-Based Update for the Treatment of Adult Congenital Patients

“…6 More recently, catheter-based balloon valvuloplasty with or without RVOT stenting has been used as the initial palliation in neonates with TOF to improve arterial oxygen saturation and pulmonary arterial growth. 7 The timing of surgical repair has been controversial and evolving over the years. Before the 1970s, most patients with TOF underwent palliative surgery that involved the creation of a systemic-pulmonary shunt followed by delayed intra-cardiac repair.…”