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Ten-years, single-center experience with arterial duct stenting in duct-dependent pulmonary circulation: early
Giuseppe Santoro1, Gianpiero Gaio1, Luca Giugno1
1Paediatric Cardiology and Cardiac Surgery, a.O.R.N. "Ospedali Dei Colli", 2nd University of Naples, Naples, Italy.
Insights
Arterial duct (AD) stenting is a feasible and effective low-risk procedure for congenital heart disease with duct-dependent pulmonary circulation (CHD-DPC). This intervention promotes significant pulmonary artery growth, particularly in patients with hypoplastic pulmonary arteries.
Area of Science:
- Interventional Cardiology
- Pediatric Cardiology
- Congenital Heart Disease
Background:
- Arterial duct (AD) stenting is a cost-effective alternative to surgical palliation for duct-dependent pulmonary circulation (CHD-DPC).
- Existing data on AD stenting outcomes are often limited to small series or multicenter studies with varied approaches.
Purpose of the Study:
- To evaluate the early results, learning curve, and mid-term outcomes of arterial duct (AD) stenting in patients with CHD-DPC.
- To assess the feasibility and efficacy of AD stenting in a high-volume tertiary referral center.
Main Methods:
- A retrospective analysis of 119 patients who underwent AD stenting for CHD-DPC between April 2003 and December 2013.
- Evaluation of procedural success, complication rates, in-hospital mortality, need for subsequent shunts, and mid-term follow-up data.
Main Results:
- Successful AD stenting was achieved in 93.3% of cases, with a 17.6% complication rate and 3.6% in-hospital mortality.
- Elective Blalock-Taussig shunts were required in 13.5% of patients; no rescue shunts were needed.
- Significant and balanced pulmonary artery (PA) growth was observed post-stenting (Nakata Index +113%), with superior growth in patients with initially hypoplastic PAs.
Conclusions:
- AD stenting is a feasible and effective low-risk palliative strategy for CHD-DPC.
- The procedure promotes significant pulmonary artery growth, especially beneficial for patients with hypoplastic main PAs at the time of duct stabilization.
Objectives:
To evaluate early results, learning-curve changes, and mid-term outcome of arterial duct (AD) stenting in congenital heart disease with duct-dependent pulmonary circulation (CHD-DPC) in a high-volume, tertiary referral center.
Background:
In spite of wide acceptance as cost-effective alternative to surgical palliation, AD stenting indications, results and mid-term outcome still largely depend on small series, experiences in particular subsets of patients or multicenter series with different approaches and interventional philosophy.
Methods:
Between April 2003 and December 2013, 119 patients underwent AD stenting as lower-risk palliation of CHD-DPC at our Institution. Procedural and mid-term follow-up data of these patients are reported.
Results:
The procedure was successfully completed in 93.3% of cases, with a complication rate and in-hospital mortality of 17.6% and 3.6%, respectively. No patient underwent rescue surgical shunt but elective Blalock-Taussig shunt was needed in 15 patients (13.5%). Over time, favorable trends toward higher feasibility and efficacy in complex ductal anatomy as well as lower procedural risk were recorded. Presurgical cardiac catheterization (n = 36) showed significant and balanced pulmonary artery (PA) growth (Nakata Index +113 ± 101%; left PA z-score +87 ± 52%; right PA z-score +97 ± 53%, P < 0.001 for all comparisons), without significant changes of left-to-right PA diameter ratio. PA growth was significantly better in patients with severely hypoplastic PAs at the time of duct stabilization (Nakata Index increase 194 ± 115 vs. 75 ± 61%, P < 0.001).
Conclusions:
AD stenting is feasible and effective at low-risk in a high percentage of patients with CHD-DPC, promoting significant and balanced PA growth mainly in patients with hypoplastic main PAs at duct stabilization.
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