Congenital Heart

Surgery: Reducing
operative trauma with
Intra-operative
Pulmonary Artery
Stenting

Redmond P. Burke MD
Chief, Division of Cardiovascular
Surgery
The Congenital heart Institute
Miami Children’s Hospital and Arnold
Palmer Hospital
www.pediatricheartsurgery.com
This technique requires a team.
You’ll need a functional relationship between
your surgeons and interventional cardiologists.
Clinical situations where intra-operative
stents have been useful:
Proximal Branch pulmonary
artery stenosis not easily
reached with on-lay patch or
homograft
– RPA behind the aorta
Traditional surgical approach
might require ischemic arrest,
aortic transection, and patch
might be crushed by aorta,
leaving persistent obstruction
– Distal LPA embedded in scar
from prior surgery
Traditional surgical approach
might injure left phrenic,
recurrent laryngeal
 Trick 3. Get your team familiar with
Endoscopic Imaging
We have the imaging
system on the table
for every operation,
and routinely take
intraop images of
each procedure.
Everyone is familiar
with the equipment,
making it
straightforward to use
for intraop stenting
Trick 4. Share and save the images
We routinely take endoscopic images of every operation,
documenting each lesion before and after repair.
We upload all intra-operative images to a web based
database whicha can be accessed on demand,
anywhere, anytime.
The images become a retrievable visual reference for
subsequent procedures in the lab or OR.
We have developed a family access version of the
database so that patients and families have access to
these images for all time.

https://irounds.mch.com
 If you anticipate placing a distal PA stent, avoid dissecting
the distal vessels. This allows the surrounding scar to serve
as a buttress, and protects the left phrenic nerve.
You can cross fresh suture lines and deploy stents without
suture rupture.
We pass a soft sucker tip parallel to the stent and
catheter, in front of the endoscope to clear distal
blood and position the stent
To prevent stent dislodgement during balloon retrieval, we
use a sucker tip or forceps to hold the stent in position
while removing the balloon catheter.
 We manually trim and flare kissing stents under direct
vision, at the cost of a pair of scissors. This creates a clear
path through the stented vessels for future interventions.
 To prevent stent “migration”, we
occasionally secure stents in position with
sutures if they feel loose in the vessel.
Thank you