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Long-term evolution of stents implanted in branch pulmonary arteries.

支架植入分支肺动脉的长期演变。

  • 影响因子:2.06
  • DOI:10.1016/j.acvd.2020.05.016
  • 作者列表:"Ma I","El Arid JM","Neville P","Soule N","Dion F","Poinsot J","Chantepie A","Lefort B
  • 发表时间:2021-01-01
Abstract

BACKGROUND:Branch pulmonary artery stenosis complicates the management of congenital heart diseases. Surgical branch pulmonary artery angioplasty is associated with a high reintervention rate. As an alternative, percutaneous or intraoperative branch pulmonary artery stents have been implanted to improve efficiency, but long-term evaluations are limited. AIM:To describe the long-term evolution of branch pulmonary artery stents. METHODS:We conducted a retrospective cohort study at Tours University Hospital. All stents implanted by surgery or catheterization in branch pulmonary arteries with a minimum follow-up of 12 months and at least one catheterization control were included. The primary endpoint combined cardiovascular mortality, surgical or percutaneous reintervention for stent complication or new stent implantation. RESULTS:Between 2007 and 2017, 76 stents in 51 patients were included (62 stents implanted by surgery, 14 by catheterization). At implantation, the patients' mean age and weight were 4.7years (interquartile range 4.2years) and 17.3kg (interquartile range 11.0kg), respectively. Mean branch pulmonary artery minimum diameter was 4.1±2.1mm (mean Z-score-4.9±2.9), and mean initial stent diameter was 9.1±3.1mm. During a follow-up of 5.3years (range 0-11.2 years), freedom from primary endpoint was 86.8% (95% confidence interval 79.6-94.8%) at 1 year, 71.5% (95% confidence interval 61.9-82.7%) at 5years and 69.6% (95% confidence interval 59.6-81.2%) at 10 years. We did not identify any factors associated with major adverse cardiovascular events. Among stents without major adverse cardiovascular events, the mean branch pulmonary artery diameter Z-score at last evaluation had increased by +4.8±3.2 compared with the initial diameter (P<0.001). After stent implantation, a median of 2 re-expansions were performed for each stent (range 0-7). CONCLUSIONS:Stent implantation should offer a good long-term solution for branch pulmonary artery stenosis, although iterative re-expansions are required.

摘要

背景: 肺动脉分支狭窄使先天性心脏病的治疗复杂化。外科分支肺动脉成形术与高再介入率相关。作为替代方案,经皮或术中分支肺动脉支架已被植入以提高效率,但长期评价有限。 目的: 描述肺动脉分支支架的长期演变。 方法: 我们在Tours大学医院进行了一项回顾性队列研究。包括所有通过手术或导管插入术在分支肺动脉中植入的支架,至少随访12个月,并且至少一次导管插入控制。主要终点合并心血管死亡率、支架并发症的手术或经皮再介入或新的支架植入。 结果: 2007-2017共纳入51例患者的76个支架 (手术植入62个支架,导管插入14个支架)。植入时,患者的平均年龄和体重分别为4.7岁 (四分位距4.2岁) 和17.3千克岁 (四分位距11.0千克岁)。平均肺动脉分支最小直径为4.1 ± 2.1毫米mm (平均Z-score-4.9 ± 2.9mm),平均初始支架直径为9.1 ± 3.1毫米mm。在5.3年的随访期间 (范围0-11.2年),1年时无主要终点的情况为86.8% (95% 置信区间79.6-94.8%),5年时为71.5% (95% 置信区间61.9-82.7%),10年时为69.6% (95% 置信区间59.6-81.2%)。我们没有发现任何与主要不良心血管事件相关的因素。在无主要不良心血管事件的支架中,末次评估时平均肺动脉分支直径Z-score与初始直径相比增加了 + 4.8 ± 3.2 (P<0.001)。支架植入后,每个支架的平均再扩张2次 (范围0-7)。 结论: 支架置入术是治疗肺动脉分支狭窄的一种长期有效的方法,但需要反复再扩张。

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