Medium-term outcomes for peripheral pulmonary artery stenting in adults with congenital heart disease

Objective: We describe our medium-term outcomes for peripheral pulmonary artery stenting in adults with congenital heart disease. Background: Improved outcomes in congenital heart disease have lead to the evolution of transcatheter therapies in adults aimed at maintaining normal hemodynamics. Stenting for pulmonary artery narrowing is effective in children, however little is known about outcomes in adults. Methods: Retrospective data analysis and follow-up review of our complete experience with peripheral pulmonary artery stenting in adults. Results: Over a 9-year period we carried out 15 procedures, implanting 23 stents (11-left pulmonary artery) in the pulmonary arteries of 12 adult patients (7 female). Eleven patients had previous cardiac surgery. Median age at implantation was 32.5 years (range, 18.7-56.7 years) with median weight of 71.3 kg (range, 44.5-95 kg). Six patients underwent bilateral pulmonary artery stenting. Median procedure time was 140 minutes (range, 76-263 minutes) and 4 patients had other interventions performed during the same procedure. Median systolic pressure gradient across the narrowing's of 24 mmHg (range, 11-61 mmHg) was reduced to 3 mmHg (range, 0-17 mmHg) postprocedure (P < 0.001). Three patients had acute stent embolization, one of whom required surgical removal. No aneurysm formation or significant stent fractures have been noted on median follow-up of 27.4 months (range, 1-97 months). Two patients required reintervention with further stent implantation. Conclusions: Pulmonary artery stenting provides effective relief of narrowing in adults with congenital heart disease. Bilateral and/or multiple stenting are often required. Stent embolization may occur particularly in patients with associated significant pulmonary regurgitation.