Page 14 - Journal of Structural Heart Disease Volume 4, Issue 4

Meeting Abstracts
116
4. HYBRID STENTING IN TREATMENT OF THE OBSTRUCTIVE PATHOLOGY OF THE AORTIC ARCH IN LOW-WEIGHT CHILDREN AFTER SURGICAL CORRECTION OF COMPLEX CHD
Manolis Pursanov, Konstantin Shatalov, Mikhail Chiaurelli, Andrey Sobolev, David Berishvilli, Alexey Kim, Andrey Svobodov, Irina Arnautova, Ashot Baveyan
A.N. Bakoulev Scienti c Center for Cardiovascular Surgery, Moscow, Russian Federation
Aim: to demonstrate possibility of hybrid management of the obstructive aortic arch pathology in low weight chil- dren after surgical correction of complex congenital heart disease (CHD).
Materials and methods: hybrid interventions were carried out in 3 patients with various CHD. Patients was 8, 22, 27 month and weight 5,7; 8,0; 11,9 kg. In rst patient we per- formed hybrid stenting using Valeo stent 7x18 mm through descending aorta after primary surgical repair of the com- mon arterial trunk (CAT) type 1with aortic arch restenosis. In second patient with HLHS after Norwood procedure we performed simultaneous stenting of stenotic segments of the obstructive arch of the neo aorta and pulmonary artery (PA). Neoarotic arch was stented using intrastent LD Max 26 mm on a 14 mm balloon though the ascending aorta, next we performed stenting of the left using Valeo stent 6x18 though the right PA with the following BT-shunt reforma- tion. In third patient with Williams syndrome, after surgi- cal management of the supravalvular aortic stenosis using Doty technique an acute dissection of the ascending aorta and aortic arch was registered. We performed intraopera- tive hybrid stenting of the ascending aorta and aortic arch using 2 Valeo stents 8х18 and 8х26 mm.
Results: no complications were registered during hybrid procedure. All patients were discharged from the hospital with good clinical results. After aortic arch stenting in rst two patients no systolic pressure gradient (SPG) were reg- istered (86 and 66 mmHg respectively before operation). In third patient with Williams syndrome stent implantation allowed to manage acute aortic dissection and to reduce SPG from initial 177 mmHg to 15 mmHg after operation.
Conclusion: Intraoperative hybrid stenting is e ective and safe method of treatment of the obstructive pathology of the aortic arch in low-weight children. Stents designed for further dilatation in a follow-up period can provide a good long-term prognosis.
5. HYBRID STENTING OF HYPOPLASTIC PULMONARY ARTERIES IN SURGICAL REPAIR OF COMPLEX CHD
Manolis Pursanov, Konstantin Shatalov, Mikhail Chiaurelli, David Berishvilli, Alexey Kim, Andrey Sobolev, Irina Arnautova, Ashot Baveyan
A.N. Bakoulev Scienti c Center for Cardiovascular Surgery, Moscow, Russian Federation
Objective: to determine results and e ciency of hybrid stenting of the pulmonary artery in patients with various CHD with the obstructive pathology of the pulmonary artery (PA).
Methods: hybrid stenting of the PA was performed in 26 patients (28 lesions) with various CHD. Patient age was from 10 month to 19 years (median 4,5+4,7) and weight from 5,3 to 77 kg (median 18,7+18,8). Hybrid stenting was performed in 14 patients (53,9 %) under 3 years old (y.o.), in 5 (19,2%) – from 3 to 6 y.o. and in 7 (26,9%) – older than 6 y.o. Hybrid stenting was performed in operation suit using mobile angiographic C-arm GE 9900. In 9 (34,6%) patients PA stenting was performed during hemodynamic correc- tion of CHD, in 5 (19,2%) – during primal surgical repair of CHD, in 6 (23,1%) – in patients with complications after surgical repair of CHD and in 6 (23,1%) – in patients with hypoplastic left heart syndrome. In general 7 operations were performed as an emergency procedure and in 19 – as a scheduled surgery. Stenting of left PA was performed in 18 cases, of right PA – in 9 cases and in 1 case we performed a stenting of the pulmonary trunk.
Results: in 25 (96,2%) of 26 patients hybrid stenting was e ective. In 1 case (3,8%) after balloon expansion, stent migrated to the proximal part of the left LA which resulted in surgical removal and repair of the left PA ostium. After stent implantation in all cases, we achieved a complete management of the PA obstruction. One patient (after pri- mal repair of the PA atresia) died due to increasing polyor- ganic insu ciency in short follow-up period, remaining 25 patients were discharged from a hospital with signi cant improvement.
Conclusion: intraoperative hybrid stenting is e ective and save procedure. Vascular access should be determined individually, according to patient anatomy and morpho- logical speci cs of CHD. Hybrid procedure allows more e ective and safe hemodynamic and primal surgical repair. In cases of complications, they can be managed with direct surgical intervention.
Journal of Structural Heart Disease, August 2018
Volume 4, Issue 4:114-206