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Abstract

Background: Congenital cardiac interventions are progressing at a rapid pace. In the last few years, techniques such as stent placement for pulmonary artery stenosis, right ventricle outflow tract and ductal stenting showed great advances. Surgery over stents are increasing in complexity. Left pulmonary artery and right ventricle outflow tract sites account for more than half of stent handling. Percutaneous devices are not an ‘‘enemy’’ for the surgeon, but a tool for continuing the development of our surgical strategies. In this study, we describe the short-term outcome of patients who underwent surgical repair after pulmonary interventions for congenital heart diseases at our institute. Methods and results: We are presenting this observational study of 17 patients who had operated over the last seven years, between 2017 and 2024. Those patients had previous catheter interventions in the form of stent implantations at different pulmonary sites. Most of these interventions had done in pediatric cardiology department at our institute. Five patients obtained interventions in left pulmonary artery (LPA), three had stent in right pulmonary artery (RPA), and two patients had right ventricle outflow tract (RVOT) stenting. Six patients had ductus arteriosus stenting and one patient had bilateral LPA and RPA stenting. The surgical procedures performed in the 17 patients were as follows: Cavopulmonary connection in two patients, completion Fontan in one patient, total correction of Tetralogy of Fallot in nine patients, MBT shunt in three patients, one patient had Rastelli type repair for VSD + pulmonary atresia and one patient had RV- PA conduit replacement and bilateral pulmonary arterial replacement. All Patients of this series had discussed in a multidisciplinary heart team(MDT) prior to surgical intervention to ensure a comprehensive and individualized plan for each patient and dealing with the stents intraoperatively based on individual case by case scenario either: external ligation of the stent, partial removal or complete removal. Three of our series had single ventricular pathway, while the rest had biventricular pathway, two cases required deep hypothermic arrest due to emergent situation in the distal arch of the aorta at the site of ductus insertion. In this series, we had one operative mortality in a patient who had previous PDA stenting for initial management of severe form tetralogy of Fallot and pulmonary hypoplasia, patient had total correction and reconstruction of the left pulmonary artery. Patient died one day post-operative from massive bleeding in the ICU. Conclusion: As the field of intervention expands greatly in adult cardiology, the same had occurred in congenital cardiac interventions. This should expand the horizon of cardiac surgeons. As surgeons gain experience in the management of patients with previous congenital intervention, interventionists may be encouraged to do complexity that is highly advanced.

Article Type

Original Study

Subject Area

Cardiology

IRB Number

IHC00089

Creative Commons License

Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License
This work is licensed under a Creative Commons Attribution-NonCommercial-Share Alike 4.0 International License.

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