Abstract 2345: Improving Outcomes in High Risk Tetralogy of Fallot Patients with Right Ventricular Outflow Tract Stenting
Background: Symptomatic infants with tetralogy of Fallot (TOF) and hypoplastic pulmonary arteries have higher risk for primary surgical repair. In our institution, palliation with only balloon angioplasty of the right ventricular outflow tract (RVOT) and pulmonary valve has been inconsistent and short-lived.
Objectives: To evaluate our experience with percutaneous transcatheter stent implantation in the RVOT in symptomatic TOF patients.
Methods: Retrospective review at the Hospital for Sick Children in Toronto, Canada from 1994 until 2007 (Group I). Outcomes were compared with our institutional primary surgical repair patients (n = 44, Group II).
Results: Ten stent procedures performed in 8 patients. Median age at first intervention was 22 days (range, 3 to 119). Median weight was 3.2 kg (2.1 to 4.1). Indication for intervention was desaturation below 70% or prostaglandin dependency. Two patients required a second stenting procedure for progressive RVOT obstruction at 67 and 122 days of life. There were no major procedural complications. Discharge post stent implantation occurred at a median of 4 days (1 to 12). Median number of days from initial stent implantation to next intervention was 108 days (44 to 315). Left and right pulmonary artery diameter Z-score increased from a median of −4.3 and −3.5 to −0.9 and −0.8 respectively before surgery. For Group I and II respectively, surgical data were: repair at median age of 142 days (44 to 413) compared to 24 days (5 to 112) (P<0.001), median weight at surgery 5.3 kg (4.0 to 9.3) and 3.2 kg (2.0 to 5.9) (P<0.001), median bypass time 99 minutes (66 to 127) and 118 minutes (54 to 264) (P=0.03), median ventilator days 4 (0 to 11) and 6 (1 to 97) (P=0.08), median days in intensive care unit was 5 (2 to 12) versus 8 (2 to 161) (P=0.09), time to discharge was 16 days (5 to 29) and 16 days (6 to 230) (P=0.35). There was no mortality in Group I and 2 late hospital deaths in Group II.
Conclusion: Stenting of the RVOT in TOF patients safely and effectively palliated symptomatic patients. This promoted development of more favourable pre-operative conditions and translated to excellent surgical outcomes. This approach represents a powerful adjunct to the management armamentarium for this challenging patient population.