Sharma Mayank, Shibbani Kamel, Khallaf Mohamed, Nijres Bassel Mohammad, Aldoss Osamah
Division of Pediatric Cardiology, Stead Family Children's Hospital, University of Iowa, 200 Hawkins Dr, BT-1010, Iowa City, IA, 52241, USA.
Division of Pediatric Cardiology, Icahn School of Medicine at Mount Sinai, New York City, NY, USA.
Pediatr Cardiol. 2025 Jun 26. doi: 10.1007/s00246-025-03931-4.
Our aim is to describe the experience of ductal stenting using the balloon-expandable Valeo stent in ductal-dependent systemic circulation. Outcomes assessed were procedural success, procedural survival, stent related complications, and re-intervention rates. Hybrid palliation, consisting of ductal stenting and bilateral pulmonary artery band placement, is a widely accepted alternative for stage I palliative surgery. Off-label use of stents is the norm for this procedure. The Valeo stent is one such example with minimal data on its use for ductal stenting. Retrospective data was collected for seventeen patients who underwent the hybrid procedure with ductus arteriosus stenting and pulmonary artery banding between November 2019 and September 2024. Descriptive statistics were performed. Seventeen patients underwent the hybrid procedure between November 2019 and September 2024 with a median age of 14 days (IQR 10-20 days) and median weight of 3.47 kg (IQR 3.2-4.2 kg). Fifteen patients had a single stent implanted at the time of the initial procedure and two patients required an additional stent. There were no intraoperative deaths, there was one in-hospital death. The interstage mortality was 30%, 12 out of 17 patients survived to subsequent planned procedure. The median duration to subsequent palliation was 157 days, during which no patients developed any in-stent stenosis or stent migration. The re-intervention rate was 35%. This consisted of 5 patients that required additional stents in the inter-stage period to address the ductal constriction in the pulmonary or aortic end and 1 patient that required balloon angioplasty for somatic growth. The Valeo stent can be a suitable option for ductal stenting during hybrid procedure in patients with hypoplastic left heart syndrome and other left heart obstructive lesions. It is an effective stent for maintaining ductal patency with good safety profile and a low rate of in-stent stenosis due to intimal proliferation during the inter-stage period.
我们的目的是描述在依赖导管的体循环中使用球囊扩张式Valeo支架进行导管支架置入术的经验。评估的结果包括手术成功率、手术生存率、支架相关并发症和再次干预率。由导管支架置入术和双侧肺动脉环扎术组成的混合姑息治疗是I期姑息手术广泛接受的替代方案。支架的标签外使用是该手术的常态。Valeo支架就是这样一个例子，其用于导管支架置入术的数据极少。收集了2019年11月至2024年9月期间接受动脉导管支架置入术和肺动脉环扎术混合手术的17例患者的回顾性数据，并进行了描述性统计。2019年11月至2024年9月期间，17例患者接受了混合手术，中位年龄为14天（四分位间距10 - 20天），中位体重为3.47 kg（四分位间距3.2 - 4.2 kg）。15例患者在初次手术时植入了单个支架，2例患者需要额外植入支架。术中无死亡病例，有1例院内死亡。过渡期死亡率为30%，17例患者中有12例存活至后续计划手术。至后续姑息治疗的中位时间为157天，在此期间无患者出现任何支架内狭窄或支架移位。再次干预率为35%。这包括5例在过渡期需要额外植入支架以解决肺动脉或主动脉端导管狭窄的患者，以及1例因身体生长需要球囊血管成形术的患者。对于左心发育不全综合征和其他左心梗阻性病变的患者，Valeo支架在混合手术期间可作为导管支架置入术的合适选择。它是一种有效的支架，可维持导管通畅，安全性良好，在过渡期内膜增生导致的支架内狭窄发生率较低。
