The Power Of Collaboration: Exploring The Potential Of Hybrid Pulmonary Vein Intervention For Pulmonary Vein Stenosis
Alyssa Blane Kalustian, MD, Paige E. Brlecic, MD, Ravi Birla, PhD, Michiaki Imamura, MD, Christopher Caldarone, MD, Manish Bansal, MD.
Texas Children's Hospital, Houston, TX, USA.
Objective: Treatment strategies for pediatric pulmonary vein stenosis (PVS) remain plagued by progressive, recurrent disease. The role of hybrid pulmonary vein intervention (HPVI) is evolving, leveraging surgical access and customization to optimize patency and opportunities for future trans-catheter procedures. We review a diverse single-center experience to explore outcomes and potential applications of this collaborative approach.Methods: All HPVI cases (pulmonary vein balloon angioplasty or stent placement during any cardiac operation) from 2009 to 2023 were reviewed.
Results: 8 patients with primary (n=4) or post-repair (n=4) PVS underwent HPVI at median age of 11.6 months (range 6.6 months-9.5 years). Concurrent surgical PVS repair was performed in 5/8 cases. HPVI was performed on 15 veins, 11 with prior surgical or trans-catheter intervention(s). One patient had balloon angioplasty of existing stent. In total, 16 stents (8 bare metal [5-10 mm diameter], 8 drug-eluting [3.5-5 mm diameter]) were placed in 14 veins. At first angiography (median 23.5 [7-122] days postoperatively), 6/14 HPVI-stented veins had in-stent stenosis. Two patients died from progressive PVS early in the study, one prior to planned reintervention. Median time to first pulmonary vein reintervention was 85 days (10-153 days; n=6 patients). At median survivor follow-up of 1.9 years (49 days-11.5 years), only 1 HPVI-stented vein was completely occluded.Conclusions: HPVI is a feasible adjunct to existing PVS therapies, with promising flexibility to address limitations of surgical and trans-catheter modalities. Reintervention is often expected and planned rather than intervention failure. Evaluation of long-term benefits and durability are warranted as utilization increases.
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