Abstract
Objective. To evaluate the effectiveness of hybrid stenting of narrowing’s and/or hypoplasia’s of the branches of the pulmonary artery during surgical correction complex congenital heart defects.
Material and methods. The study was carried out in the period from 2012 to 2023 based on the Bakoulev National Medical Research Center for Cardiovascular Surgery. The study included 81 patients with obstructive lesions of the branches of the pulmonary artery in combination with complex congenital heart defects. Depending on the anatomical and morphological features of the heart defect and previous surgical interventions on the heart, the patients were conditionally divided into 4 groups: group 1 – 37 (45.7%) patients who underwent hemodynamic correction; group 2 – patients who underwent radical correction (RC) 17 (21%); 17 (21%) patients who underwent re-intervention after radical correction were included in group 3 and group 4 – patients after staged correction of complex congenital heart defects 10 (12.3%). The control points were the assessment of laminar blood flow, the absence of a gradient on the stent and the absence of cardinal complications (perforation, rupture of the pulmonary artery and death of the patient).
Results. The hybrid approach allows successful hemodynamic correction in 89.2% and radical correction in 94.2% of complex congenital heart defects combined with obstructive lesions of the branches of the pulmonary artery. Stent implantation was successful in 98.8% of cases. Intraoperative complication developed in 6.2% (n = 5) cases, and intraoperative mortality developed in 2.5% (n = 2) cases, and was associated with the initial severity of the patients and only in 1 (1.2%) case was associated with implantation of a stent in the pulmonary artery. Overall hospital mortality was 12.3% (n = 10) of the case and was due to the initial severity of the patients' condition and emergency interventions. The main indications for stenting of the PA branches are hemodynamically significant stenosis (59.5%), hypoplasia (35.7%) and occlusion of the PA (4.8%). An effectively performed hybrid intervention (correction of congenital heart disease and stenting of the pulmonary artery) made it possible to improve the clinical condition of patients.
Conclusion. Hybrid stenting of narrowing’s and/or hypoplasia’s of the pulmonary arteries for surgical correction of complex congenital heart defects, it is the most effective and safe intervention with an immediate success rate of 98.8%.
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About the authors
- Vladimir P. Podzolkov, Dr. Med. Sci., Academician of the Russian Academy of Sciences, Deputy Director for Scientific Work; ORCID
- Karen V. Petrosyan, Dr. Med. Sci., Head of the Department, Chief of Chair; ORCID
- Konstantin V. Shatalov, Dr. Med. Sci., Professor, Deputy Director for Scientific Work, Head of the Department; ORCID
- Timur Yu. Danilov, Dr. Med. Sci., Head of the Department; ORCID
- Dmitriy V. Kovalev, Dr. Med. Sci., Head of the Department; ORCID
- Andrey V. Sobolev, Cand. Med. Sci., Leading Researcher; ORCID
- Gulamzhan M. Dadabaev, Cand. Med. Sci., Researcher; ORCID
- Farkhodzhon M. Dadabaev, Postgraduate; ORCID
