Long-Term Outcomes of Intraoperative Pulmonary Artery Stent Placement for Congenital Heart Disease Michael J. Angtuaco, 1 * MD, Ritu Sachdeva, 1 MD, Robert D.B. Jaquiss, 2 MD, W. Robert Morrow, 1 MD, Jeffrey M. Gossett, 3 MS, Eudice Fontenot, 1 MD, and Paul M. Seib, 1 MD Objective: Our objective was to examine long-term outcomes of intraoperative pulmonary artery stents and determine risk factors for reintervention Background: Short-term outcomes of intraoperative pulmonary artery stents have been reported previously. However, long-term results are unknown. Methods: We conducted a retrospective review of patients who underwent intraoperative pulmonary artery stent placement for branch pulmonary artery stenosis. Results: Ninety-six stents were implanted intraoper- atively in 67 patients. Twenty-seven patients received two or more stents at initial inter- vention. Median patient age at initial stent placement was 1.8 years. Median post-infla- tion diameter was 8 mm. At a mean follow-up of 7.6 6 4.5 years, 49% of stents required reintervention (balloon angioplasty at catheterization in 28 patients and surgi- cal revision in 19 patients). Actuarial freedom from reintervention at 2, 5, and 10 years was 68%, 49%, and 40%, respectively. In univariate analysis of time to first reinterven- tion, age at implantation < 2 yrs (P < 0.0009) and initial post-inflation stent diameter < 10 mm (P < 0.0002) were associated with risk for reintervention. Multivariable Cox regression analysis showed age < 2 years (P < 0.005) and diagnosis of tetralogy of Fal- lot (p < 0.002) or truncus arteriosus (P < 0.007) to be significant risk factors for reinter- vention. Conclusion: Intraoperative placement of stents in the pulmonary arteries is an alternative to surgical angioplasty, but is associated with a high incidence of reinter- vention. Age < 2 years and the diagnosis of tetralogy of Fallot or truncus arteriosus are risk factors for reintervention. V C 2010 Wiley-Liss, Inc. Key words: outcomes; intraoperative stent; branch pulmonary artery stenosis INTRODUCTION Branch pulmonary artery stenosis has been managed using both surgical and percutaneous approaches [1]. A hybrid approach utilizing intraoperative implantation of PA stents has been used to relieve branch PA stenosis in patients in whom percutaneous stent implantation is not technically feasible or who are undergoing con- comitant surgery to address other cardiac abnormalities [2–5]. Compared with traditional surgical patch angio- plasty, this hybrid approach can be performed without cardiopulmonary bypass and can potentially shorten bypass time when bypass is employed [6]. When com- pared to the percutaneous technique, the hybrid approach has the advantage of much better access to the involved PA and also allows for placement of a stent dilatable to adult size, even in a small infant [6]. This approach also permits the immediate recognition and treatment of complications such as stent emboliza- tion and vascular rupture [6]. While the immediate benefits of this approach are obvious and have been reported previously, long-term results are not known [7–9]. A large, single-center 1 Department of Pediatrics, University of Arkansas for Medical Sciences, Pediatric Cardiology, Little Rock, Arkansas 2 Department of Surgery, University of Arkansas for Medical Sciences, Pediatric Cardiothoracic Surgery, Little Rock, Arkan- sas 3 Department of Pediatrics, University of Arkansas for Medical Sciences, Biostatistics, Little Rock, Arkansas *Correspondence to: Michael J. Angtuaco, MD, Fellow, Department of Pediatrics, Pediatric Cardiology, University of Arkansas for Medi- cal Sciences, Arkansas Children’s Hospital, 1 Children’s Way, Slot 512-3, Little Rock, AR 72202. E-mail: mjangtuaco@uams.edu Received 18 May 2010; Revision accepted 27 August 2010 DOI 10.1002/ccd.22797 Published online 3 November 2010 in Wiley Online Library (wileyonlinelibrary.com) V C 2010 Wiley-Liss, Inc. Catheterization and Cardiovascular Interventions 77:395–399 (2011)