This study summarizes the outcomes of a surgical technique for pulmonary artery reconstruction in 56 patients who had previously failed pulmonary artery stent procedures. The surgery successfully removed prior stents in 71% of cases and repaired peripheral pulmonary arteries distal to stents in 91% of patients. Following surgery, central pulmonary artery pressures significantly decreased compared to preoperative levels. At 2 years, freedom from death or need for reintervention was 87%. The study concludes that this surgical reconstruction approach can be very effective for managing pulmonary artery stenosis in patients with a history of failed pulmonary artery stenting.

1. Journal Review :
Pulmonary Artery Reconstruction After
Failed Pulmonary Artery Stents
Ann Thorac Surg 2020;110:949-55
Richard D. Mainwaring, MD, R. Thomas Collins, MD, Kirstie L. MacMillen, PA,
Michal Palmon, BS, MPH, and Frank L. Hanley, MD
Divisions of Pediatric Cardiac Surgery and Cardiology, Lucile Packard Children’s Hospital Stanford,
Stanford University School of Medicine, Stanford, California
Reviewer : Su Chan Lim

2. Introduction
• PA stenosis
- Associated with wide spectrum of CHD
- RV pressure ↑, maldistribution of PA flow
- May result severe RV hypertension, Rt. heart failure, death
• Conventional treatment strategy of PA stenosis
- Within the hilum  surgical
- Outside the hilum  intervention (balloon, stent)

3. Introduction
• New surgical technique for PA stenosis
- For peripheral PA stenosis
- Can be applicable for patients with failed PA stents

4. Materials & Methods
• Study populations
- Single-center retrospective review
- January 2014 ~ August 2019
- 56 Patients
- Referred to Stanford University d/t failed PA stenting

5. Materials & Methods
• Study populations
- 22 patients (41%) had identifiable syndromes:
DiGeorge (n=9), Alagille (n=8), Williams (n=3),
Down (n=1), Partial deletion of chromosome 19 (n=1)
- Underlying CHDs :
Congenital heart defect Patients (n)
PA-VSD with MAPCA 26
Peripheral PA stenosis 11
TOF 10
Truncus arteriosus 3
TGA 3
DORV 2
HLHS 1

6. Materials & Methods
• Study populations
- Previous cardiac surgery (median = 2)
- Previous cardiac catheterization: median = 4
- PA stents (median = 2)
Surgery 0 1 2 3 4 5
Patients 1 23 19 7 5 1
Stents 1 2 3 4
Patients 25 19 7 5

7. Materials & Methods
• Surgical procedure

8. Results
• Age distribution

9. Results
• Characteristics
Characteristics Patients Median values
CPB time 56 / 56 (100%) 402 (60 – 844) min
ACC time 23 / 56 (41%) 34 (12 - 162) min
Completely removed
stent
81 / 104 (71%)
Peripheral PA repair
distal to the stent
51 / 56 (91%) 14 (3-28) ea
Hospital length of stay 10 (4 – 59) days
Follow up duration 1.8 (0.08 – 5.3) years
Reoperation 1 / 56 (1.7 %)

10. Results
• Concomitant procedures

11. Results
• Central PA-to-Aortic pressure ratio
Preop. Postop.

12. Results
• Central PA-to-Aortic pressure ratio
0.91 ± 0.21
0.31 ± 0.07

13. Results
• Freedom from death or reintervention
87% at 2 years

14. Conclusion
• Surgical pulmonary artery reconstruction
- Resulted in significant decreases in the central PA
- Can be very successful in the setting of prior PA stenting

15. Thank you for your attention!

16. Appendix