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Patent Ductus Arteriosus Stenting in Infants with Duct-Dependent Pulmonary Circulation: An Indian Experience
Deepali Bangalia1, Hemanta Nayak1, Sudipta Bhattacharjya1
1Pediatric Cardiology Department, The Mission Hospital Durgapur, Durgapur, India.
Insights
Patent ductus arteriosus (PDA) stenting using drug-eluting coronary stents is a safe and effective palliative strategy for neonates with duct-dependent pulmonary circulation, improving procedural and follow-up outcomes.
Area of Science:
- Pediatric Cardiology
- Interventional Cardiology
- Neonatology
Background:
- Patent ductus arteriosus (PDA) is a critical condition in neonates with duct-dependent pulmonary circulation.
- Timely intervention is crucial for managing these complex congenital heart defects.
Purpose of the Study:
- To evaluate the outcomes of PDA stenting using the latest generation drug-eluting coronary stents.
- To assess the safety and efficacy of this strategy in neonates with duct-dependent pulmonary circulation.
Main Methods:
- Retrospective, observational study including 58 infants with duct-dependent pulmonary circulation.
- PDA stenting performed using drug-eluting coronary stents.
- Follow-up for up to 12 months post-procedure.
Main Results:
- Successful stent deployment in 100% of patients.
- Low in-hospital mortality (6.9%) and 12-month mortality (reported deaths up to 12 months).
- 19 patients underwent univentricular repair, 4 underwent biventricular repair within 12 months.
Conclusions:
- PDA stenting with latest-generation drug-eluting coronary stents is a safe and effective palliative strategy.
- This approach offers improved procedural and follow-up outcomes for neonates with duct-dependent pulmonary circulation.
Introduction:
The study aimed to evaluate outcomes of patent ductus arteriosus (PDA) stenting using the latest generation drug-eluting coronary stents in neonates with duct-dependent pulmonary circulation.
Methods:
This was a retrospective, observational study which included infants who were diagnosed with duct-dependent pulmonary circulation and underwent PDA stenting at a tertiary care center in India. All pre- and post-procedural details of each patient were retrospectively collected from the medical records of the hospital. All the patients were regularly followed up for up to 12 months in the outpatient clinic until the subsequent surgical procedure following the PDA stenting.
Results:
A total of 58 patients who underwent PDA stenting were included in the study. The mean age was 50.22 ± 67.69 days, and mean weight was 3.18 ± 1.15 kg. Among all, 24 (41.4%) patients were prematurely born (<37 gestational weeks). A total of 35 (60.3%) patients required prostaglandins before PDA stenting to maintain patency of the duct until the procedure. The mean PDA diameter at pulmonary artery end was 2.75 ± 0.63 mm, and the mean PDA length was 17.19 ± 4.68 mm. A total of 60 drug-eluting coronary stents were implanted across 58 PDAs with Tetrilimus everolimus-eluting stents being the most implanted (35%). The mean implanted stent length and diameter were 19.50 ± 5.61 mm and 4.06 ± 2.39 mm, respectively. Successful stent deployment at the intended position across the PDA was achieved in all 58 (100%) patients. During hospital stay, four (6.9%) cases of in-hospital mortality were reported. Post-discharge, three deaths were reported up to 12-month follow-up. During 12-month follow-up, 19 (32.8%) patients underwent univentricular surgical repair, while four (6.9%) underwent biventricular surgical pair. Two (3.4%) patients required stent retrieval and subsequently underwent palliative shunting.
Conclusion:
The PDA stenting with the latest generation drug-eluting coronary stents is found safe and clinically better palliative care strategy for patients with duct-dependent pulmonary circulation, resulting in improved procedural and follow-up outcomes.
