Balloon expandable stents for systemic venous pathway stenosis late after Mustard's operation

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Abstract
Objectives Description and evaluation of current experience with the use of balloon expandable stents for the relief of systemic venous pathway stenosis late after Mustard’s operation. Design Retrospective observational study of technical procedures, angiographic, and haemodynamic findings. Patients Twenty long term survivors of Mustard’s operation for transposition of the great arteries (TGA) with angiographic evidence of systemic venous pathway narrowing. Intervention Systemic venous pathway stenoses were stented using balloon expandable Palmaz stents. Results Twenty seven stents were deployed across 24 stenoses. Seventeen stents were placed in the inferior baffle (16 patients), with an increase in mean (range) minimum diameter from 9.6 (4.5–15.9) to 16.5 (11.9–22.2) mm (p = 0.007), and a reduction in mean pressure gradient from 3.1 (0–8) to 0.67 (0–3) mm Hg (p = 0.002). Eight stents were placed in the superior pathways of eight patients, with diameters widened from 9.1 (3.5–14.1) to 15.2 (8.7–19.2) mm (p = 0.018), and gradients reduced from 6.4 (2–11) to 0.9 (0–2) mm Hg (p = 0.02). Two badly deployed stents were safely withdrawn from their intracardiac positions and redeployed in the iliac vein. Transvenous pacemaker insertion was facilitated by prior stent insertion. Conclusions The use of balloon expandable stents for late systemic pathway narrowing after Mustard’s operation is safe and effective. The beneficial effects of stenting are likely to be more durable than those of balloon angioplasty alone, but longer term follow up is required.