Abstract
Aim of the study – to represent our experience in complete repair of cyanosis heart defects by means of
hybrid approach.
6 patients with pulmonary stenosis (tetrada of Fallot – 4 patients, pulmonary atresia with ventricular septal
defects (VSD) – 2 patients) after previously performed palliation with high risk of conventional surgery.
Previously all patients had systemic-to-pulmonary sunt, right ventricular outflow tract reconstruction without
VSD closure was performed in in 3 patients, and balloon angioplasty of the pulmonary artery (PA) –
2 patients.
Surgery was performed in a conventional operating room (with mobile C-arm) on cardiopulmonary bypass,
moderate hypothermia and kardioplegia. The hybrid phase was pulmonary artery stenting in 4 patients (right
PA – 1, left PA – 1, both branches – 2), patent systemic-to-pulmonary shunt closure and major aorto-pulmonary
collateral arteries embolization in 2 patients.
Hybrid surgery was successful in 5 patients. In 1 case, due to left pulmonary artery stent migration distal
to stenotic site, conventional plasty was performed. All patients were discharged from hospital on 17,0±7,1
(9–27) day after surgery.
Close cooperation between surgeons and interventionists is one of the key points in successful treatment
of patient with complex congenital heart defects, especially those requiring staged repair. Hybrid approach
is a safe alternative to conventional surgery in high risk cyanotic patients with pulmonary stenosis and additional
sources pulmonary blood flow.
References
- Podzolkov V.P., Kokshenev I.V. Tetralogy of Fallot.Мoscow; 2008 (in Russ.).
- Kirklin J.W., Barratt-Boyes B.G. Cardiac surgery. N.Y:
Churchill Livingstone; 2013.
- Bockeria L.A., Alekyan B.G. Guidelines for endovascu-lar surgery. Мoscow; 2009 (in Russ.).
- Petit C.J., Gillespie M.J., Harris M.A., Seymour T.L.,
Liu T.Y., Khan A. et al. Relief of branch pulmonary
artery stenosis reduces pulmonary valve insufficiency in
a swine model. J. Thorac. Cardiovasc. Surg. 2009; 138:
382–9. DOI: 10.1016/j.jtcvs.2009.02.030
- Podzolkov V.P., Alekyan B.G., Kokshenev I.V., Che-ban V.N. Reoperation after repair of congenital heartdefects. Moscow; 2013 (in Russ.).
- Chiaureli M.R., Samsonov V.B., Pursanov M.G.,Mataev V.S. Hybrid operation with complete correctionof tetralogy of Fallot following a previously performedcalcified systemic-pulmonary anastomosis according toBlelok–Taussig. Bakoulev Journal of CardiovascularDiseases.2015; 16 (5): 46–50 (in Russ.)
- Schmitz C., Esmailzadeh B., Herberg U., Lang N.,
Sodian R., Kozlik-Feldmann R. et al. Hybrid procedures
can reduce the risk of congenital cardiovascular
surgery. Eur. J. Cardiothorac. Surg. 2008; 34 (4):
718–25. DOI: 10.1016/j.ejcts.2008.06.028
- Windhausen F., Boekholdt S.M., Bouma B.J.,
Groenink M., Backx A.P.C.M., de Winter R.J., Mulder
B.J.M. et al. Per-operative stent placement in the
right pulmonary artery; a hybrid technique for the management
of pulmonary artery branch stenosis at the
time of pulmonary valve replacement in adult Fallot
patients. Neth. Heart J. 2011; 19 (10): 432–5. DOI:
10.1007/ s12471-011-0195-0
- Winston L., Boekholdt S.M., Hazekamp M.G., de Winter
R.J., Koolbergen D.R. Hybrid branch pulmonary
artery stent placement in adults with congenital heart
disease. Thorac. Surg. 2015; 20 (4): 499–503. DOI:
10.1093/icvts/ivu435
- O'Laughlin M.P., Perry S.B., Lock J.E., Mullins C.E.
Use of endovascular stents in congenital heart disease.
Circulation. 1991; 83 (6): 1923–39. DOI: 10.1161/
01.CIR.83.6.1923
- McMahon C.J., El-Said H.G., Grifka R.G., Fraley
J.K., Nihill M.R., Mullins C.E. Redilation of
endovascular stents in congenital heart disease: factors
implicated in the development of restenosis and neointimal
proliferation. J. Am. Coll. Cardiol. 2001; 38 (2):
521–6. DOI: 10.1016/S0735-1097(01)01406-1
- Bergersen L., Lock J.E. What is the current option of
first choice for treatment of pulmonary arterial stenosis?
Cardiol. Young. 2006; 16 (4): 329–38. DOI: 10.1017/
S1047951106000679
- Agrawal H., Alkashkari W., Kenny D. Evolution of
hybrid interventions for congenital heart disease. Expert
Rev. Cardiovasc. Ther. 2017; 15 (4): 257–66. DOI:
10.1080/14779072.2017.1307733
- Peters B., Ewert P., Berger F. The role of stents in the
treatment of congenital heart disease: Current status
and future perspectives. Ann. Pediatr. Card. 2009; 2 (1):
3–23. DOI: 10.4103/0974-2069.52802
- Bokenkamp R., Blom N.A., de Wolf D., Francois K.,
Ottenkamp J., Hazekamp M.G. Intraoperative stenting
of pulmonary arteries. Eur. J. Cardiothorac. Surg. 2005;
27 (4): 544–7. DOI: 10.1016 /j.ejcts.2005.01.013
- Menon S.C., Cetta F., Dearani J.A., Burkhart H.A.,
Cabalka A.K., Hagler D.J. Hybrid intraoperative pulmonary
artery stent placement for congenital heart disease.
Am. J. Cardiol. 2008; 102 (12): 1737–41. DOI:
10.1016/j.amjcard.2008.07.061
About the authors
- Samsonov Viktor Borisovich, Dr. Med, Sc., Leading Researcher; orcid.org/0000-0002-6477-7914
-
Chiaureli Mikhail Rаmazovich, Dr. Med. Sc., Professor, Deputy Head of Department; orcid.org/0000-0002-6456-9269
-
Kovalev Dmitriy Viktorovich, Dr. Med. Sc., Leading Researcher; orcid.org/0000-0002-4586-9258
-
Pursanov Manolis Georgievich, Dr. Med. Sc., Head of Department for X-ray Endovascular and Intraoperative Diagnostics and Treatment of Cardiovascular Diseases; orcid.org/0000-0002-1421-1795
-
Danilov Timur Yur'ievich, Dr. Med. Sc., Leading Researcher; orcid.org/0000-0002-9409-3230
-
Mataev Viktor Sergeevich, Cand. Med. Sc., Leading Researcher; orcid.org/0000-0003-4386-1233
-
Zemlyanskaya Inga Vladimirovna, Dr. Med. Sc., Leading Researcher; orcid.org/0000-0001-5114-8492
-
Podzolkov Vladimir Petrovich, Dr. Med. Sc., Professor, Academician of Russian Academy of Sciences,
-
Head of Department for Surgery of Older Children with Congenital Heart Defects; orcid.org/0000-0002-2863-2072
