Abstract 1931: Analysis of Stent Fractures after Percutaneous Pulmonary Valve Implantation
Background- We analysed the incidence, risk factors and treatment options for stent fractures after percutaneous pulmonary valve implantation (PPVI).
Methods and Results- 123 patients after PPVI had chest x-ray, in anteroposterior (AP) and lateral projection, echocardiography and clinical evaluation during structured follow-up. 24 (19.5%) developed stent fractures, 0 – 843 days after PPVI (stent fracture free survival, 1 year 87%, 2 years 75% and 3 years 69%). Stent fracture was classified as Type I: no loss of stent integrity (n = 18), Type II: loss of integrity with restenosis on echocardiography (n = 5) and Type III: separation of fragments or embolisation (n = 1). In a multivariate Cox regression we analysed various factors, of which three were associated with a higher risk of stent fracture: implantation into native right ventricular outflow tract (RVOT) (p = 0.03), non-calcified RVOT (p = 0.02, Fig. 1⇓), and recoil of PPV during balloon deflation (p = 0.01). Substernal stent localization, high-pressure post-dilatation of PPV, AP and lateral stent dimensions did not pose increased risk. Patients with Type I fracture remain under follow-up, those with Type II fracture were investigated for feasibility for 2nd PPVI (3 had 2nd PPVI with relief of re-stenosis, 1 awaiting, 1 under medical follow-up) and one patient with Type III fracture required surgical explantation.
Conclusions- Stent fractures after PPVI can be managed effectively by risk stratification, systematic classification and anticipatory management strategies. Serial x-ray and echocardiography is recommended for surveillance.