Complex cases undergo step surgical and percutaneous procedures, including
stent deployment. Concerns arise on
stent removal at latest surgery. Our initial experience is presented. Forty-six
stents in 35 patients were partially or totally removed at surgery.
Univentricular heart was diagnosed in 20 patients.
Stents were previously deployed in: ductus (6), right ventricle outflow tract (12),
atrial septal defect (4), right pulmonary artery (4), left pulmonary artery (16), inferior vena cava (2), superior vena cava (1) and ascending aorta (1).
Surgical procedures performed: 9 transplants, 6 Fontan, 4 Glenn, 1 comprehensive repair (Norwood + Glenn), 1 Glenn takedown, 8 conduit replacement, 2 Fallot, 2 Rastelli, 1
ventricular septal defect closure and 1 iatrogenic aortopulmonary window. Five ductal
stents were clipped. Eleven
stents in right ventricle, four ones in
atrial septal defect, two in right pulmonary artery, seven in the left pulmonary artery and two in inferior vena cava were completely removed. Two
stents in right pulmonary artery, one in superior vena cava, one in ascending aorta and nine in the left pulmonary artery were partially retrieved. Handling the
stents in ductus, right ventricle and
atrial septal defect was straightforward. On the contrary,
stent removal in the ductus (comprehensive case), pulmonary branches, both vena cavae or aorta required short periods of deep
hypothermia with circulatory arrest. Surgery over
stents is increasing in complex, step procedures.
Univentricular hearts are most prevalent. Congenital transplant surgery faces new challenges.
Stent removal at the time of surgery may require
deep hypothermic circulatory arrest.