Balloon angioplasty, stent procedures safe soon after pediatric congenital heart surgery
Click Here to Manage Email Alerts
Balloon angioplasty and stent implantation procedures in the early postoperative period after congenital heart surgery are overall relatively safe and effective, data from a retrospective, single-center study show.
“There is limited experience reported in literature for cardiac catheterization therapy, especially balloon angioplasty and stent implantation procedures, in the early postoperative period after congenital heart surgery in children,” Daniel Quandt, MD, of the division of pediatric cardiology at the Pediatric Heart Centre at University Children’s Hospital Zurich, and colleagues wrote in the Journal of Cardiac Surgery. “Generally, these interventions are considered potential high‐risk procedures associated with an elevated rate of morbidity and mortality. Therefore, cardiac catheterization during the early postoperative period is often avoided or postponed. The interventionist performing the procedure must balance potential peri‐ and postinterventional risks and benefits. For balloon angioplasty and stent implantation procedures in the early postoperative period, this balancing includes decision-making on safety, as well as effective balloon and stent diameters, while performing interventions across fresh surgical suture lines in potentially unstable patients.”
Source: Adobe Stock
In a retrospective study, Quandt and colleagues analyzed data from 127 balloon angioplasty and stent implantation procedures performed in 104 children within 30 days after congenital heart surgery from 2001 to 2021 (median, 6.5 days after surgery).
The balloon‐to‐stenosis ratio and balloon‐to‐reference vessel ratio were smaller compared with the stent‐to‐stenosis ratio and stent‐to‐reference vessel ratio (P < .001 and P = .005, respectively). Researchers observed a greater rise in absolute vessel diameter (P < .001), greater rise in vessel diameter in relation to the stenosis (P = .01) and vessel diameter in relation to the reference vessel with stent implantation (P < .001).
Up to 94% of stent implantations fulfilled both success criteria, defined as an increase of vessel diameter of at least 50% of minimal vessel diameter or achievement of at least 75% of the reference vessel diameter. Major adverse events were more frequent in the balloon angioplasty group (P = .05). Intraprocedural complication rates were 16% for the balloon angioplasty group and 13% in the stent implantation group (P = .77).
“Comparison of the occurrence rates of adverse events in this study and the occurrence rates of adverse events in normal and elective cardiac catheterization procedures in children in the literature shows similar adverse event rates, supporting the hypothesis that early postoperative cardiac catheterizations are relatively safe,” the researchers wrote. “As the occurrence rate of adverse events is low in both groups, early postoperative balloon angioplasty or stent implantation should not be postponed. Nevertheless, these interventions should be considered high risk and procedural preparation and a multidisciplinary approach with good surgical and intensive care backup are essential.”
Collapse
Click Here to Manage Email Alerts