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  • Title: Stent implantation is effective treatment of vascular stenosis in young infants with congenital heart disease: acute implantation and long-term follow-up results.
    Author: Stanfill R, Nykanen DG, Osorio S, Whalen R, Burke RP, Zahn EM.
    Journal: Catheter Cardiovasc Interv; 2008 May 01; 71(6):831-41. PubMed ID: 18412081.
    Abstract:
    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.
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