Hybrid and Endovascular Approaches for Critical Defect in Newborns
Sergey Kovalev, Sergey Bykov, Andrey Bulynin, Ivan Timoshin, Denis Gryznov
Voronezh Medical University, Voronezh, Russian Federation
BACKGROUND: Analysis of endovascular and hybrid methods of treatment for critical CHD was purpose of the study.METHODS: 28 newborns with ductal-dependent CHD underwent to endovascular and hybrid procedures. Group 1 (n = 18) endovascular procedures. The mean age is 13.3 ± 22.2 days, the mean weight is 3.3 ± 0.5 kg. Nosological forms - critical aortic stenosis - 14, 2 with combination coarctation (CoAo), critical CoAo - 1, tricuspid atresia (TA) - 4. Procedures: aortic valve balloon valvuloplasty (BAV) 14, angioplasty of CoAo in 1, stenting of PDA - in 4. Group 2 (n = 10) - hybrid interventions. The mean age is 8.8 ± 7.6 days, the mean weight is 2.8 ± 0.6 kg. The group comprised: patients with HLHS -3, IAA with SV- 2, IAA with VSD -1, pulmonary artery atresia (PA) with VSD - 3 and PAIVS -1. Stenting of PDA with bilateral pulmonary banding - 6, direct stenting of PDA - in 4, of them 1 was combined with a balloon valvuloplasty.RESULTS: 1 group. Repeated interventions required 4 patients, of them 3 - BAV, and 1 Ross procedure. Bidirectional cavapulmonary shunt was performed in all children with TA. One lethal case was noted in a patient with fibroelastosis of the left ventricle and critical aortic stenosis. 2 group. The next stage was performed by 3 children with IAA and 3 children with PA and VSD. Complications of the early and late postoperative period were stent dislocation (1) and stent thrombosis (2). Lethal outcomes in the hospital (3) and out-of-hospital (2) stages are due to heart failure in the background of concomitant pathology.CONCLUSIONS:Endovascular interventions are safe and effective in patients with critical CHD. The outcomes of hybrid interventions are due to the initial severity of the CHD and the condition of the patients.