Hybrid aortic reconstruction for treatment of recurrent XXXX after stage 1 single ventricle palliation: medium term outcomes and results of redilation.

@entity1 @entity1699 @entity661 @entity2333 @entity5596
OBJECTIVE: We describe a hybrid approach to the treatment of @entity2333 after stage 1 palliation (S1P) of @entity1699 . BACKGROUND: Recurrent @entity2333 is a common problem after S1P of @entity1699 . Even mild @entity2333 is poorly tolerated so early and definitive therapy is desirable. Although stent implantation is an effective treatment for @entity2333 in older @entity1 and adults, technical issues due to small vessels and concerns regarding future potential for expansion have generally precluded the use of stents in this setting. METHODS: Six @entity1 underwent hybrid aortic reconstruction (HAR) in the operating room or catheterization laboratory, with the interventional cardiologist and cardiac surgeon working in cooperation. RESULTS: @entity1 had a mean weight of 5.8 kg (2.9-7.7) and a mean age of 5.6 months (0.5-12.9) at the time of HAR. Five @entity1 had undergone prior balloon angioplasty at a mean age of 2.8 months (2.1-3.5), and five had moderately depressed single ventricular function prior to HAR. The balloons used had a diameter of 7-10 mm and introducer sheath size ranged from 6 to 10 F. There were no immediate or late procedure related complications. Stent redilation was performed in 5 @entity1 for relief of recurrent obstruction or to keep pace with somatic growth. At a median follow up of 4.8 years (0.2-7.9), there were 3 @entity1 progressing well after Fontan palliation and 3 deaths. CONCLUSIONS: HAR allows for placement of stents that can ultimately reach adult size in small @entity1 who have recurrent @entity661 following @entity5596 . Advantages include freedom from delivery sheath constraints when determining stent type/size, facilitation of precise stent position, and avoidance of vascular damage or hemodynamic compromise during the procedure. Longer follow-up and larger experience are required to determine if this therapy will provide a long-term solution to this difficult problem.
