Balloon Angioplasty, Safe Stent Procedures Shortly After Pediatric Congenital Heart Surgery

November 04, 2022

2 minute read


Disclosures: The authors report no relevant financial information.


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Balloon angioplasty and stent implantation procedures in the early postoperative period after congenital heart surgery are overall relatively safe and effective, according to data from a single-center retrospective study.

“The experience reported in the literature on cardiac catheterization therapy, particularly balloon angioplasty and stent implantation procedures, in the early postoperative period after congenital heart surgery in children“, Daniel Quandt, MD, of the Pediatric Cardiology Division of the Pediatric Cardiac Center at the University Children’s Hospital Zurich, and his colleagues wrote in the Journal of Cardiac Surgery. “In general, these procedures are considered potentially high-risk procedures associated with a high rate of morbidity and mortality. Therefore, cardiac catheterization in the early postoperative period is often avoided or postponed. The interventionist performing the procedure must balance the potential peri- and post-procedure risks and benefits. For balloon angioplasty and stent implantation procedures in the early postoperative period, this balance includes making decisions about safety, as well as effective balloon and stent diameters, while performing procedures on fresh surgical suture lines in potentially unstable patients.



Stent with balloon
Balloon angioplasty and stent implantation procedures in the early postoperative period after congenital heart surgery are overall relatively safe and effective.
Source: Adobe Stock

In a retrospective study, Quandt and colleagues analyzed data from 127 balloon angioplasty and stent implantation procedures performed on 104 children within 30 days of congenital heart surgery from 2001 to 2021 (median, 6.5 days after surgery).

The balloon-to-stenosis ratio and the balloon-to-reference vessel ratio were lower compared to the stent-to-stenosis ratio and the stent-to-reference vessel ratio (P .001 and P= .005, respectively). The researchers observed a greater increase in the absolute diameter of the vessels (P .001), greater increase in vessel diameter relative to stenosis (P= .01) and vessel diameter relative to reference vessel with stent implantation (P .001).

Up to 94% of stent implantations met both success criteria, defined as an increase in vessel diameter of at least 50% of the minimum vessel diameter or achievement of at least 75% of the vessel diameter of reference. Major adverse events were more frequent in the balloon angioplasty group (P= .05). Intraprocedural complication rates were 16% for the balloon angioplasty group and 13% for the stent implantation group (P= .77).

“Comparison of adverse event occurrence rates in this study and adverse event occurrence rates in normal and elective cardiac catheterization procedures in children in the literature shows similar adverse event rates, supporting the assumption that early postoperative cardiac catheterizations are relatively safe,” the researchers wrote. “Because the rate of occurrence of adverse events is low in both groups, early postoperative balloon angioplasty or stent implantation should not be postponed. Nevertheless, these procedures should be considered high risk and procedural preparation and a multidisciplinary approach with good surgical and intensive care assistance are essential.