Abstract
Objective. We aimed at the efficacy evaluation of the staged hybrid approach to the tetralogy of Fallot (TOF) definitive repair in low birthweight patients using the stenting of right ventricular outflow tract (RVOT) as the first stage of surgical treatment.
Material and methods. Since June 2012 to August 2016 we operated 16 patients aged from 1 day to 2.5 months. The congenital heart disease anatomy was presented by TOF with hypoplasia of pulmonary artery branches and the expressed obstruction of RVOT. Progressing cyanosis and weight less than 3 kg were the indications for RVOT stenting in newborns. Definitive repair of TOF with the stent explantation was performed in 14 patients on average 3.2 months after RVOT stenting. The stent explantation was performed without technical difficulties. After the explantation from right ventricular outflow tract the bare-metal stent was subjected to histological analysis using light microscopy.
Results. All patients after successful stenting of right ventricular outflow tract had no signs of hypoxemia and were extubated in the early terms. The patients stayed at hospital on average for 3.5 days, then they were transferred to neonatal in-patient facilities for fur-ther developmental care considering the low body mass and the presence of comorbidity. The adequate development of left ventricle and pulmonary artery branches allowed to perform a definitive repair of TOF on average after 3.2 months. There was not any post-operative and long-term mortality in the average follow-up period of 48.5 ± 1.2 months. In the obtained samples the bare-metal stent together with the surrounding tissues formed a “new” vessel, the histological structure of which differed from the typical structure of arteries. No necrosis and microthrombosis were observed.
Conclusion. Stenting of RVOT is an effective and safe procedure in low birthweight TOF patients with progressing cyanosis, it cre-ates favourable conditions for the following definitive repair.
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About the authors
- Nokhrin Andrey Valer'evich, MD, PhD, Senior Research Associate, Cardiac Surgeon;
- Tarasov Roman Sergeevich, MD, DM, Endovascular Surgeon, Chief of Laboratory;
- Mukhamadiyarov Rinat Avkhadievich, MD, PhD, Senior Research Associate;
- Barbarash Leonid Semenovich, Academician of Russian Academy of Sciences
