Stenting of the right ventricular outflow tract as primary palliation for Fallot-type lesions

Background: To describe the institutional experience, technical aspects and outcome of stenting of the right ventricular outflow tract (RVOT) in the initial palliation of symptomatic patients with severely limited pulmonary blood flow. Methods: Retrospective case note and procedure review of patients undergoing stenting of the RVOT over a 10 year period at a quarternary institution. Patients: Between 2005 and 2014, 76 selected patients underwent cardiac catheterization with the aim to implant a stent into an obstructed RVOT to improve pulmonary blood flow. Median age at stent implantation was 57 (range 4–406) days and median weight was 3.4 (1.7–12.2) kg. Results: Seventy-two patients underwent stent implantation. Median procedure time was 53 (23–260) and fluoroscopy time 14 (5.2–73) minutes. Stents were implanted through either 4 F or 6 F sheaths. Median stent diameter was 5 (4–7) mm and stent length 16 (12–24) mm. There was one procedural death (1.4%) and one emergency surgery (1.4%). Saturations increased from 70 (52–83)% to 93(81–100)% [p < 0.001]. Within 30 days, two patients required early shunts due to inadequate palliation and two died from non-cardiac causes. Conclusion: Stenting of the RVOT is an effective treatment option in the initial palliation of selected patients with very reduced pulmonary blood flow due to severe right ventricular outflow tract obstruction.