Endovascular stent placement for right ventricle to pulmonary artery conduit stenosis in the Norwood with Sano modification.

OBJECTIVE

Conduit obstruction is increasingly recognized as a complication of the Sano modified Norwood procedure. We report our experience with stent placement to ameliorate conduit stenoses and prevent premature surgical intervention.

DESIGN

Records for all patients having undergone a Sano modified Norwood between September 2003 and December 2006 were reviewed. All patients with Sano conduit obstruction requiring stent placement were included. Sites of obstruction, method of stenting, pre- and poststent oxygen saturations, reinterventions, age at next surgery, and complications were collected and reviewed.

RESULTS

Forty-one patients underwent a Sano modified Norwood procedure, and 9 patients had stents deployed for conduit stenoses. The patients presented a median of 52 days following Norwood palliation. Twelve stents were successfully placed in 9 patients. In 8 patients, saturations improved from a median of 67.5% to 81% after stent placement (P = .0005). Arterial saturations were unavailable in 1 patient requiring extracorporeal membrane oxygenation. No patients required reintervention after stent placement. The median age at their next surgery was 144 days. Seven patients underwent a successful bidirectional Glenn, 1 patient underwent a modified Blalock-Taussig shunt, and 1 expired. Complications included hypotension during stent deployment and 1 episode of transient complete heart block.

CONCLUSIONS

Transcatheter treatment of Sano conduit obstruction can be performed safely and results in immediate improvement in oxygenation, thereby allowing substantial delay of the cavo-pulmonary shunt.