Stenting and overdilating small Gore-Tex vascular grafts in complex congenital heart disease.
BACKGROUND
Gore-Tex® grafts are integral in the management of congenital heart disease. Issues of graft stenosis or somatic outgrowth may precipitate high-risk early surgery, and catheter intervention is a relatively under-reported management option.


OBJECTIVES
To assess efficacy, safety, and outcomes of stenting and overdilating small Gore-Tex® vascular grafts with the aim of optimizing surgical timing.


METHODS
Retrospective analysis of single-center, 13-year experience of 93 graft stenting interventions or reintervention in 80 patients, with the aim of relieving stenosis ± overdilation, to depose surgical graft revision or optimize surgical timing and candidacy.


RESULTS
Median preintervention graft diameter was 52% (IQR 43-63) of nominal size, postintervention this increased to median 102% (IQR 96-120) [P < 0.001]. Overdilation was achieved in 54%; of these, the median final internal lumen was 126% (IQR 113-132) [P < 0.001]. Mean oxygen saturations increased from 69% to 82% [P < 0.001]. Adverse event rate was 14.9%; this includes mortality (3.2%) and atrioventricular conduction block (8.5%). Univariate analysis and logistic regression showed a significant relationship between adverse events and young age [P < 0.01], low weight [P < 0.01], univentricular physiology [P < 0.001], use of femoral venous access alone [P = 0.03], and intervention on a right ventricle to pulmonary artery conduit [P = 0.03]. Within respective indication groups, 74% were bridged to elective cavopulmonary shunt, 95% were bridged to biventricular surgery, and 78% of long-term palliative care patients continue under follow-up.


CONCLUSIONS
Gore-Tex® vascular grafts can be stented effectively and expanded beyond nominal diameters by around +26%. This improves oxygen saturations, providing excellent palliation and optimized surgical timing. Adverse events are most frequent in precavopulmonary shunt patients.


CONDENSED ABSTRACT
Gore-Tex® grafts are widely used in the palliation of cyanotic congenital heart disease. Grafts may become stenosed and do not allow for somatic growth. Over a 13 year period, graft stenting was performed in 80 patients (93 technically successful interventions, 4 unsuccessful.) Median internal lumen change was +50% (of nominal graft size), mean oxygen saturation change +13%. Over-dilation was performed in more than half of the cohort, with a median gain of +26% on nominal graft size. In precavopulmonary shunt patients, there was a moderate incidence of serious complications. Clinically useful deferral of surgery was achieved for the majority.
['Penford|Gemma|G|0000-0002-5822-0861', 'Quandt|Daniel|D|', 'Mehta|Chetan|C|', 'Bhole|Vinay|V|', 'Dhillon|Rami|R|', 'Seale|Anna|A|', 'Stumper|Oliver|O|']
D000800:Angioplasty, Balloon D001807:Blood Vessel Prosthesis D019917:Blood Vessel Prosthesis Implantation D005260:Female D006083:Graft Occlusion, Vascular D006330:Heart Defects, Congenital D006801:Humans D008297:Male D011138:Polytetrafluoroethylene D011474:Prosthesis Design D011475:Prosthesis Failure D015641:Radiography, Interventional D012189:Retrospective Studies D012307:Risk Factors D015607:Stents D013997:Time Factors D016896:Treatment Outcome D014654:Vascular Patency
stent overdilation Gore-Tex shunt Norwood