Pulmonary branch stenting is a relatively recent technique, now widely used worldwide, but remains insufficiently studied, particularly regarding its long-term efficacy and tolerability. The objectives of our study were to assess long-term stent efficacy and survival in pulmonary branches, to evaluate the effectiveness of subsequent redilations, to document procedure-related complications, and to identify predictive factors associated with stent survival.

We conducted a retrospective, multicentre, observational study including all patients who underwent percutaneous or surgical implantation of a stent in one or both pulmonary artery (PA) branches. The primary endpoint was stent survival free from surgical removal, percutaneous re-stenting, branch occlusion, or cardiac-related death.

Between 2004 and 2025, 159 patients (55% male; mean age 7.5 ± 9.1 years) underwent 215 pulmonary branch stent implantations. The most frequent underlying congenital heart diseases were pulmonary atresia with ventricular septal defect (28%), tetralogy of Fallot (24%) and single ventricle physiology (14%). A genetic abnormality was identified in 19% of patients. Most stents were implanted percutaneously (65%), predominantly in paediatric patients (88%), and resulted in a significant increase in the pulmonary branch minimal diameter Z -score (from −5.0 ± 2.6 to 0.0 ± 1.7, P < 0.001). Mean follow-up was 6.3 ± 5.0 years, covering 206 stents (95%). The primary endpoint occurred in 24% of stents after a mean of 2.3 ± 3.2 years. Stent survival free from the primary endpoint was 78% at 10 years. Factors associated with endpoint occurrence were younger age and lower weight at implantation, smaller baseline pulmonary artery diameter, and the use of non-redilatable stents. Long-term complications included 41 cases of in-stent proliferation (20%), 21 fractures (10%), 7 migrations (3%), and rarer events (PA–aortic fistula, aortic compression, dissection). During follow-up, 225 redilations were performed on 117 stents (1–5 per stent), increasing the initial diameter by 36 ± 33% (mean gain 2.8 ± 2.2 mm). The last available stent Z-score was normal (0.1 ± 1.4).

Pulmonary branch stenting achieves a significant and sustained increase in pulmonary artery diameter with an acceptable rate of complications. Larger-scale studies are required to refine patient selection and identify those at lower risk of long-term complications.