Upper cavo-pulmonary anastomosis by transcatheter technique

Area of Science:

• Cardiovascular Surgery
• Interventional Cardiology
• Pediatric Cardiac Interventions

Background:

• The upper cavo-pulmonary anastomosis (UCPA) is a critical surgical step for infants with univentricular anatomy.
• Current procedures involve open-chest surgery and cardiovascular bypass, carrying significant risks.
• An interventional technique could potentially replace this surgical step, minimizing risks.

Purpose of the Study:

• To establish a shunt connection between the superior vena cava (SVC) and the right pulmonary artery (RPA) using solely transvascular intervention.
• To evaluate the feasibility of replacing the surgical UCPA with a minimally invasive interventional technique.

Main Methods:

• Four piglets underwent transvascular UCPA creation using radiofrequency perforation from the SVC to the RPA.
• Procedures were guided by biplane fluoroscopy, followed by implantation of expanded polytetrafluoroethylene (ePTFE)-covered stents.
• Catheterization involved jugular and femoral vein cannulation, SVC perforation, and RPA stent deployment.

Main Results:

• Immediate angiography confirmed antegrade flow from SVC to RPA post-intervention.
• Follow-up angiography at 4 weeks showed partial in-stent stenosis but maintained lumen patency.
• Histology revealed parietal thrombi and mild to moderate pseudo-intima proliferation within the stents.

Conclusions:

• Transvascular creation of an upper unidirectional cavo-pulmonary anastomosis is technically feasible in piglets.
• This interventional approach utilizes standard catheterization equipment.
• Further research may explore its potential as a less invasive alternative to surgical UCPA.