Stent implantation is effective treatment of vascular stenosis in young infants with congenital heart disease: acute implantation and long-term follow-up results.

BACKGROUND

Stents implantation in infants has been shown to be feasible, however, there are no published reports examining long-term outcomes. Concerns exist regarding creation of fixed obstructions secondary to the stent if expansion to larger diameters over time is not possible.

METHODS

A retrospective analysis of the earliest consecutive series of infants who underwent stent placement at our institution between October 1995 and December 1999.

RESULTS

Implantation of 33 stents were attempted in 27 infants, median age = 10 (25-24) months, wt = 8.1 (3.4-14.5) kg. Stents used were as follows: 16 large, 13 medium, and 4 coronary. Acute implant success was 94%. There were three nonprocedure-related deaths within 30 days of implantation, 1 patient was lost to follow-up and 1 had acute stent thrombosis. The remaining 22 patients (26 stents) form the long-term follow-up study group. Nineteen stents underwent 33 redilations. Following latest redilation, 67.0 (37-113) months postimplantation, minimal luminal diameter increased from 7.0 +/- 1.8 mm immediately following implantation to 8.7 +/- 2.3 mm (P < 0.001). Seven stents were electively removed/ligated during a planned surgery. All 18 remaining in situ stents are patent without significant obstruction 102 (84-116) months following implantation. There was one late death 51 months after stent implantation. The remaining 21 patients are alive and well.

CONCLUSIONS

Stent implantation in infants is safe and effective. Serial redilation is possible to keep pace with somatic growth; however, efforts should be made to implant stents with adult diameter potential in children who will not require further cardiac surgery. Implantation of small- and medium-sized stents can provide effective palliation and should be considered in carefully selected infants who will ultimately require future surgery.