Acute and long-term effects of endovascular debanding of pulmonary arteries in a swine model

Michael Perez, Tk Susheel Kumar, Deepthi Hoskoppal, Yada Akkhawattanangkul, Kimberly Allen, Christopher J. Knott-Craig, Benjamin Rush Waller, Shyam Sathanandam

Research output: Contribution to journalArticle

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Abstract

Objectives: The primary objective of this study was to demonstrate that pulmonary artery (PA) debanding via cardiac catheterization using balloon angioplasty is feasible and safe in swine. The secondary objectives were to determine the acute and long-term effects of this therapy. Design: This is a chronic survival experimental study in newborn swine. Background: PA bands are used in infants for transient palliation of congenital heart defects with excessive pulmonary blood flow. Although rare, if these defects should close spontaneously or become hemodynamically insignificant, a sternotomy and occasionally cardiopulmonary bypass may still be required for band removal. Alternatively, debanding could be accomplished through less invasive methods. Interventions: The main pulmonary artery was banded in three piglets, and the left pulmonary artery in five piglets via mini-thoracotomy at a mean weight of 2.5 kg. Following a threefold increase in weight, the piglets underwent PA debanding via balloon angioplasty. Four piglets were sacrificed to evaluate the acute effects. The remainder were followed to evaluate long-term effects. Histopathology was performed on all piglets. Outcome measures: Reintervention rates. Histopathologic consequences of high pressure balloon angioplasty used for PA debanding acutely and after reinterventions. Results: Debanding was performed at a mean weight of 8.1 ± 2.23 kg. The median preintervention gradient across the band was 18 mm Hg. Debanding was successful in all piglets. The median postintervention gradient was 3.5 mm Hg. All piglets in the long-term model required re-interventions for recurrent stenosis at mean weights of 26 ± 1.6 and 61 ± 3.2 kg. Histopathology demonstrated vessel wall injury in only one piglet. Conclusions: Endovascular PA debanding can be safely achieved in a swine model. Angioplasty following debanding may be necessary for recurrent stenosis. This catheter-based therapy may provide a less-invasive alternative to surgery.

Original languageEnglish (US)
Pages (from-to)340-349
Number of pages10
JournalCongenital Heart Disease
Volume12
Issue number3
DOIs
StatePublished - May 1 2017

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Pulmonary Artery
Swine
Balloon Angioplasty
Weights and Measures
Pathologic Constriction
Sternotomy
Congenital Heart Defects
Thoracotomy
Cardiac Catheterization
Cardiopulmonary Bypass
Angioplasty
Catheters
Outcome Assessment (Health Care)
Pressure
Lung
Wounds and Injuries
Therapeutics

All Science Journal Classification (ASJC) codes

  • Pediatrics, Perinatology, and Child Health
  • Surgery
  • Radiology Nuclear Medicine and imaging
  • Cardiology and Cardiovascular Medicine

Cite this

Perez, M., Kumar, T. S., Hoskoppal, D., Akkhawattanangkul, Y., Allen, K., Knott-Craig, C. J., ... Sathanandam, S. (2017). Acute and long-term effects of endovascular debanding of pulmonary arteries in a swine model. Congenital Heart Disease, 12(3), 340-349. https://doi.org/10.1111/chd.12449

Acute and long-term effects of endovascular debanding of pulmonary arteries in a swine model. / Perez, Michael; Kumar, Tk Susheel; Hoskoppal, Deepthi; Akkhawattanangkul, Yada; Allen, Kimberly; Knott-Craig, Christopher J.; Waller, Benjamin Rush; Sathanandam, Shyam.

In: Congenital Heart Disease, Vol. 12, No. 3, 01.05.2017, p. 340-349.

Research output: Contribution to journalArticle

Perez, M, Kumar, TS, Hoskoppal, D, Akkhawattanangkul, Y, Allen, K, Knott-Craig, CJ, Waller, BR & Sathanandam, S 2017, 'Acute and long-term effects of endovascular debanding of pulmonary arteries in a swine model', Congenital Heart Disease, vol. 12, no. 3, pp. 340-349. https://doi.org/10.1111/chd.12449
Perez M, Kumar TS, Hoskoppal D, Akkhawattanangkul Y, Allen K, Knott-Craig CJ et al. Acute and long-term effects of endovascular debanding of pulmonary arteries in a swine model. Congenital Heart Disease. 2017 May 1;12(3):340-349. https://doi.org/10.1111/chd.12449
Perez, Michael ; Kumar, Tk Susheel ; Hoskoppal, Deepthi ; Akkhawattanangkul, Yada ; Allen, Kimberly ; Knott-Craig, Christopher J. ; Waller, Benjamin Rush ; Sathanandam, Shyam. / Acute and long-term effects of endovascular debanding of pulmonary arteries in a swine model. In: Congenital Heart Disease. 2017 ; Vol. 12, No. 3. pp. 340-349.
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