Abstract 18478: Balloon Angioplasty of Branch Pulmonary Arteries in Children: A Long Term Outlook
Introduction: Balloon angioplasty (BA) is widely employed for branch pulmonary artery stenosis (BPAS) in children. Vessel recoil, and hence need for repeat intervention, is common.
Hypothesis: BA of BPAS has poor long term outcomes.
Methods: We reviewed our cath database over an 11-year period ending in 2013 and collected data for all pts undergoing BA for BPAS. Primary endpoint was repeat intervention (RI), with other endpoints including acute results, and need for stent or surgical PA plasty (S/S). Central branch pulmonary artery (cPA) was defined as pre-hilum, while peripheral BPA (pPA) was define as post-hilum.
Results: 175 pts underwent 371 BA procedures for BPAS. Primary diagnosis included major aorto-pulmonary collateral arteries (MAPCAs) in 18% (n=32) pts, and single ventricle in 11% (n=20) pts. Median age and weight were 23.6 (9.9 - 65.8) months and 10.7 kg (7.8 - 18.2 kg). Pt follow up was 4.1 (1.1 - 6.5) years. 69% (n=256) of BA was performed on cPA and 31% (n=115) on pPA. Acutely, there was a 14.9% (7.6 - 26.7%) improvement in stenosis in cPA, and 18.5% (9.8 - 28.6%) in pPA (p=0.053). Improvement of pressure gradient was 34.3% (10.4 - 63.4%) in cPA, and 31.6% (0 - 60.7%) in pPA (p=0.324). Higher rates of RI was seen in pPA (55% RI, p=0.035).
For cPA, freedom from RI was 69% at 1 year and 44% at 5 years. Freedom from S/S was 81% at 1 year and 62% at 5 years. Factors associated with higher rate of RI include MAPCAs (65% RI, p=0.039), younger pt age (p=0.042), and lower pt weight (p=0.047). Lower rates of RI were seen in pts with discrete (p=0.007) and severe stenosis (p<0.001). For pPA, freedom from RI was 59% at 1 year and 38% at 5 years. Freedom from S/S was 98% at 1 year and 92% at 5 years.
Conclusions: Long term outcomes of BA for BPAS are disappointing. BA for BPAS is associated with a high rate of RI with rates exceeding 50% by 5 years. Patients with pre-hilar BPAS and with discrete, severe stenosis appear to respond more favorably. Peripheral BPAS and MAPCAs in particular have a high rate of recurrence.
Author Disclosures: Y. Ooi: None. S. Kim: None. S.E. Gillespie: None. Z. Geng: None. D.W. Kim: None. R.N. Vincent: None. P.J. Christopher: None.
- © 2015 by American Heart Association, Inc.