Grafts in Children With Congenital Heart Lesions

Objective: To evaluate the efficacy and safety of expanding vascular shunt grafts beyond original nominal diameter using stents. Methods: Bench testing confirmed the expandability of 3.5 mm and 4.0 mm vascular Gore-Tex R stretch grafts. A retrospective analysis included eleven systemic to pulmonary artery shunts with diminished flow which were stented with the aim of increasing the original nominal diameter of the shunts. Results: During bench testing, the grafts could be expanded to 4.5 mm and 5.8 mm, respectively. Fourteen stents were implanted in 11 stretch grafts a median of 18.9 months (3.2; 21.6 months) after shunt surgery. There was a median increase in diameter of 1.4 mm (0.9; 1.7 mm) [P 5 0.001, 95% CI: 0.47; 1.7) from original nominal to final stented diameter of the shunts with a median gain of 28%. A simultaneous improvement in saturations from a median of 73% (66; 77%) to 87% (84; 89%) [P 5 0.015; 95% CI: 3; 22] was observed. No complications were experienced during the procedures. Conclusion: In our limited experience, stretch Gore-Tex vascular grafts can be safely expanded beyond nominal diameters using high pressure vascular stents. This leads to improvement in saturation and pulmonary blood flow. It allows the clinician to tailor pulmonary flow in relation to pulmonary artery size and growth, ensuring best possible timing for the next surgical procedure. VC 2009 Wiley-Liss, Inc.