Hybrid Stenting of the Right Ventricle Outflow Tract, as a Method of Palliative Care for Infants with a Critical Obstruction of the Right Ventricle Outflow Tract

Pavel V. Teplov, Alexey S. Ilin, Evgeniy V. Sahnov, Dmitriy P. Stolyarov, Arina V. Vityutneva, Konstantin A. Ilinyih

Federal center of cardiovascular surgery, Krasnoyarsk, Russia

Date, time and location: 2018.05.26 13:30, Exhibition area, 1st Floor. Zone – D

Abstract

Objective: Hybrid stenting of the rightventricule outflow tract (RVOT) is one of the methods of critical right ventricule obstruction palliative treatment in children with severe concomitant pathology due to multiple malformations.

Methods: Ten infants were operated with critical obstruction of RVOT and multiple malformations (respiratory, digestive, CNS, genetic syndromes). The average weight was 2.4 ± 0.86 kg, the average age was 38.1 ± 51.4 days. All children were in serious condition, 7 of them had ductus-dependent hemodynamics, 5 children had previously operated on other pathology, 6 of them had an infections process. Stenting was performed through the median sternotomy and the free wall of the right ventricle (in the case of pulmonary artery atresia, the perforation of the membrane was performed with a blunt needle). The diameter of the stent was determined as the diameter of LA + 1 mm.

Results: In 1 case was an intraoperative complication – stent dislocation in the RVOT, which was resolved by stent implantation of a longer length; 2 was required a full correction in the early postoperative period due to progressive cardiopulmonary insufficiency; 1 was required a continuous infusion of vasaprostan up to the moment of stage 2; 1 was required ECMO on the 2nd day after the operation because of a small cardiac output. In the observation period (2 years) completed full correction was performed for 3 child; the second stage of univentricular correction was performed for one patient. By the dynamic observation three children died from severe concomitant pathology.

Conclusions: The hybrid approach to the treatment of critical obstructions in children with multiple developmental defects is a palliative correction stage that allows to survive the newborns period and reduce the risks of surgical treatment. High mortality in this group of patients is due to multiple malformations, often in combination with anunfavorable prognosis for life.