The temporary stent as a bridge to congenital cardiac repair

Objectives: Nowadays the treatment of congenital cardiac defects has evolved that much that the unexpected is expected. There is a general trend to operate upon newborns at an earlier age and with smaller birth weight. To limit the exposure to multiple surgeries at an early age, the cooperation between pediatric cardiology and pediatric cardiac surgery is essential. The staging of certain procedures and patients can be advantageous for patients as well as both medical specialties. In this study a limited group of patients is described that profited from consecutive approaches with the end goal a better and more definite repair.

Methods: Ten patients received temporary stent for various reasons like infundibular stenosis at the right ventricular outflow tract or aortic stents to temporarily cure a coarctation or distal arch hypoplasia. Although all patients could have been treated surgically primarily with a palliation, due to several reasons, the intervention was chosen, to limit the surgical interventions and have a more definite repair in the near future.

Results: All 10 patients were operated within the first 4 months after the intervention, ranging from 8 weeks till 5 months. The 6 patients with subpulmonary, infundibular obstruction all received their correction around 4 months and in 5 out of 6 the pulmonary valve could be saved. In those patients the stents were removed without problems. The other 4 patients had stents in the coarctation area, where 3 out of 4 could be removed in toto and 1 of the stents had to be included into the arch enlargement. Three out of these 4 patients received a biventricular repair, although the primary opionion tended towards the univentricular path. All patients survived the operation and did well afterwards.

Conclusions: Temporary stenting can be used in specific cases as a solution for a left sided or right sided obstruction. It is important to intervene rather soon to remove the stent without too many problems due to ingrowth and neo-endotheliazation. The advantage of limiting surgical exposure and extracorporeal circultation in low birth weight infants increases the success rate of the surgical repair at a later stage.