Comparison of self-expandable and balloon expanding stents for hybrid ductal stenting in hypoplastic left heart syndrome

Balloon expandable stents (BES) are commonly used for ductal stenting during hybrid palliation of hypoplastic left heart syndrome (HLHS). A self-expanding nitinol Sinus-Superflex-DS (SSF) stent is now available for this purpose. We compared patient characteristics, implantation and mid-term performance of SSF and BES in a retrospective review of 65 neonates between 12/2005 and 02/2014.

Results: 39 SSF stents were used in 24 neonates, 10 typical HLHS and 42 BES (Palmaz Genesis - 36, Palmaz Blue - 6) in 41 neonates, 21 with typical HLHS. Comparison of patients’ age, weight, procedural and fluoroscopy times showed no difference. Patients in SSF group had significantly lower min (p=0.0069) and maximal (p=0.015) ductal diameter. Ductal length and final maximal diameter did not differ. Final minimal ductal diameter was bigger in BES group (p=0.026). Immediate stent post-dilatation was performed in 3 patients in the SSF group and 2 in the BES group (p=0.006). In SSF group 1 complication was stent related, whereas in the BES group 7 were stent related. Patients in BES group had longer ventilation (p=0.014) and intensive care unit stay (p=0.012). In the follow-up percutaneous intervention due to stent related complications was performed in 4 patients in SSF group and 3 patients in the BES group. In the SSF group there was 1 procedural and 1 hospital death. Nine patients await surgical treatment, 9 had the next stage of palliation and 4 had biventricular repair. In the BES group there were 12 hospital and 4 interstage deaths. Twenty three patients underwent the next stage of palliation and 2 had biventricular repair.

Conclusions: Although additional ductal interventions were more frequent with SSF stent, the complication rate and interstage mortality was significantly higher with balloon expandable stents.