Cardiac Operations After Patent Ductus Arteriosus Stenting in Duct-Dependent Pulmonary Circulation

Vida, Vladimiro L.; Speggiorin, Simone; Maschietto, Nicola; Padalino, Massimo A.; Tessari, Chiara; Biffanti, Roberta; Cerutti, Alessia; Milanesi, Ornella; Stellin, Giovanni

doi:10.1016/j.athoracsur.2010.04.007

Cited by 40 publications

(38 citation statements)

References 13 publications

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“…The other notable feature about this case is that the ductal stenting did not complicate subsequent surgery despite being in place for 7 months. This has been corroborated by other published reports [6].…”

Section: Discussionsupporting

confidence: 93%

“…With advances in stent design and delivery systems and with a more selective approach, later reports were more encouraging with 91% procedural success, no procedure related mortality and 89% freedom from reintervention at 6 months [3]. Further reports with similar results followed [4] with subsequent data demonstrating progressive pulmonary artery growth [5] and uncomplicated serial surgical palliation in patients following previous ductal stenting [6]. These reports have endorsed the viability of this approach, and the anatomical lesions to which it might be applied are broadening.…”

Section: Introductionmentioning

confidence: 73%

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Variable approaches to arterial ductal stenting in infants with complex congenital heart disease

Kenny

Berman

Zahn

et al. 2012

Cathet Cardio Intervent

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Stenting of the arterial duct to maintain postnatal communication between the pulmonary and systemic arterial circulations in infants with complex congenital heart disease is an acceptable alternative to a surgically created systemic to pulmonary artery shunt. The procedure, however, can be demanding given the variable anatomy of the patent ductus arteriosus. We report a series of cases of ductal stenting via a range of varying approaches in neonates with complex congenital heart disease, and display the variety of situations in which these approaches may be used.

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Section: Discussionsupporting

confidence: 93%

Section: Introductionmentioning

confidence: 73%

Variable approaches to arterial ductal stenting in infants with complex congenital heart disease

Kenny

Berman

Zahn

et al. 2012

Cathet Cardio Intervent

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“…Patent ductus arteriosus stenting has the advantages of being less invasive, thereby avoiding a median sternotomy or lateral thoracotomy, potentially avoiding exposure to cardiopulmonary bypass, and potentially allowing for more symmetric growth of the pulmonary arteries . The previously touted potential disadvantages of PDA stenting include procedural complications unique to this procedure (primarily vascular access related), concerns regarding stent longevity, and potential problems related to the ductal stent during subsequent surgical procedures …”

Section: Introductionmentioning

confidence: 99%

Blalock-Taussig shunt versus patent ductus arteriosus stent as first palliation for ductal-dependent pulmonary circulation lesions: A review of the literature

Boucek

Qureshi

Goldstein

et al. 2019

Congenital Heart Disease

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Background Infants with ductal‐dependent pulmonary blood flow (PBF) often undergo a palliative procedure to provide a stable source of PBF prior to definitive palliation or repair. In the current era, a surgical shunt or ductal stent is used to provide PBF. We aimed to review the current literature comparing ductal stents to surgical shunts. Methods and Results Four small, single‐center studies and two larger multicenter studies were identified comparing ductal stent to surgical shunt. Combined, these studies showed ductal stent resulted in similar or improved pulmonary artery growth, fewer complications, shorter length of stay, less diuretic use, and improved survival compared to surgical shunt. Despite inherent minor variability among the studies, ductal stent appears to be associated with more frequent reinterventions. Conclusions Surgical shunts remain essential to the care of these patients, but ductal stent is a reasonable alternative, and may provide some advantages in select patients with ductal‐dependent PBF.

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“…[8][9][10][11] While risk factors predisposing to reintervention in the stented PDA are unclear, it is conceivable that underlying PDA morphology contributes to in-stent narrowing and need for reintervention. Concerns regarding branch pulmonary artery (PA) jailing, future PA growth, and later need for surgical PA plasty after PDA stenting have all been raised in small series 1,2,12 and may contribute to the slow adoption of initial palliation with PDA stent implant. Understanding risk factors for reintervention and PA jailing would allow operators to make a more informed decision when considering PDA stenting for the cyanotic neonate.…”

mentioning

confidence: 99%

Classification scheme for ductal morphology in cyanotic patients with ductal dependent pulmonary blood flow and association with outcomes of patent ductus arteriosus stenting

Qureshi

Goldstein

Glatz

et al. 2019

Cathet Cardio Intervent

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Objectives To devise a classification scheme for ductal morphology in patients with ductal dependent pulmonary blood flow (PBF) that can be used to assess outcomes. Background The impact of ductal morphology on outcomes following patent ductus arteriosus (PDA) stenting is not well defined. Methods Patients <1 year of age who underwent PDA stenting for ductal dependent PBF at the four centers comprising the Congenital Catheterization Research Collaborative (CCRC) were included. A classification scheme for PDA morphology was devised based on a tortuosity index (TI)—Type I (straight), Type II (one turn), and Type III (multiple turns). A subtype classification was used based upon the ductal origin. Results One hundred and five patients underwent PDA stenting. TI was Type I in 58, Type II in 24, and Type III in 23 PDAs, respectively. There was a significant association between ductal origin and vascular access site (p < 0.001). Procedure times and need for >1 stent did not differ based on TI. Greater TI was associated with pulmonary artery (PA) jailing (p = 0.003). Twelve (11.4%) patients underwent unplanned reintervention, more commonly with greater TI (p = 0.022) and PA jailing (p < 0.001). At the time of subsequent surgical repair/palliative staging, PA arterioplasty was performed in 32 patients, more commonly when a PA was jailed (p = 0.048). PA jailing did not affect PA size at follow up. Conclusions The proposed qualitative and quantitative PDA morphology classification scheme may be helpful in anticipating outcomes in patients with ductal dependent PBF undergoing PDA stenting.

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Cardiac Operations After Patent Ductus Arteriosus Stenting in Duct-Dependent Pulmonary Circulation

Cited by 40 publications

References 13 publications

Variable approaches to arterial ductal stenting in infants with complex congenital heart disease

Variable approaches to arterial ductal stenting in infants with complex congenital heart disease

Blalock-Taussig shunt versus patent ductus arteriosus stent as first palliation for ductal-dependent pulmonary circulation lesions: A review of the literature

Classification scheme for ductal morphology in cyanotic patients with ductal dependent pulmonary blood flow and association with outcomes of patent ductus arteriosus stenting

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