Long-Term Follow-Up of Percutaneous Stent Implantation for Residual Pulmonary Artery Stenosis in Pediatric Patients after Surgical Repair of Complicated Congenital Heart DiseasesOA

Objective:The aim of the present study was to investigate long-term efficacy and safety of percutaneous stent implantation for residual pulmonary artery stenosis(PAS)in pediatric patients after surgical repair of complicated congenital heart diseases(CHDs).Methods:All pediatric patients diagnosed with residual PAS after surgical repair of complicated CHDs between 1996 and 2020 were retrospectively enrolled in the study.Results:A total of 41 patients(30 males,11 females;median age 5.0 years,median weight 17 kg)were followed-up for a median of 7.1 years.Follow-up echocardiography results demonstrated that the target vessel diameter increased from(3.4±1.1)mm preoperatively to(6.2±1.9)mm one year post-procedure and(6.0±1.5)mm at the final follow-up(p<0.05).The pressure gradient across the stenosis decreased from(52.6±15.8)mmHg preoperatively to(35.8±19.1)mmHg one year post-procedure and(33.1±19.7)mmHg at the final follow-up(p<0.05).Cardiac computed tomography scans indicated that target vessel/distal vessel diameter ratio increased from(0.4±0.2)pre-operatively to(0.8±0.2)one year post-procedure and(0.9±0.3)at the final follow-up(p<0.05).A total of six adverse events were documented,comprising two cases of in-stent restenosis requiring surgical reintervention,three cases of in-stent restenosis managed with regular clinical surveillance,and one case of percutaneous pulmonary valve replacement due to severe pulmonary regurgitation.Kaplan-Meier event-free survival analysis demonstrated that elevated preprocedural right ventricular systolic pressure(>72 mmHg)was significantly associated with long-term adverse events(p=0.024).Conclusion:Percutaneous stent implantation for residual PAS after surgical repair of complicated CHDs effectively relieves vessel stenosis,stabilizes cardiac function,and improves long-term prognosis in pediatric patients.In-stent restenosis remains an unresolved complication,necessitating further advancements in interventional strategies.