Early and midterm results of ductal stent implantation in neonates with ductal-dependent pulmonary circulation: a single-centre experience

Abstract

Objective: We aimed to determine the early and midterm outcomes of ductal stenting in neonates with ductal-dependent pulmonary blood flow. Methods: Between January, 2014 and July, 2018, 102 patients who underwent 115 cardiac catheterisation procedures for ductal stent implantation in our department were retrospectively reviewed. The age of the neonates ranged from 3 to 30 days (median: 11 days) and their weights ranged from 1.8 to 5.8 kg (mean, 2.8 ± 0.53 kg). Fifty-two patients had functional single ventricle and 50 had biventricular physiology. Thirty-one patients’ weights were <2,500 g (30.3%). The patent ductus arteriosus was vertical in 60 patients (58.8%). The mean ductal length was 12.4 ± 4.1 mm (range, 7.8–23 mm), and the mean narrowest ductal diameter was 2.1 ± 0.7 mm (range, 1.2–3.4 mm). Results: The technical success rate was 85.2%. Procedure-related mortality occurred in three patients (2.9%). After the procedure, the aortic oxygen saturation increased from a mean of 73.1 ± 6.2% to a mean of 90.4 ± 4.3% (p < 0.001), and the ductus diameter increased from a mean of 2.1 ± 0.7 mm to a mean of 4.2 ± 0.9 mm (p < 0.001). Either transcatheter or surgical reinterventions were required in 35 patients (34.3%) during the follow-up period after a median of 101 days (2–356 days). Thirty-three patients (32.3%) were bridged to surgical repair after a median of 288 days (163–650 days). The median duration of palliation with ductal stents was 210 days (range, 2–525 days). Conclusion: Ductus arteriosus stenting may be a reasonable and effective alternative to surgery for the initial palliation procedure in neonates with ductus-dependent pulmonary flow.

Blalock-Taussig Shunt versus Ductal Stenting as Palliation for Duct-Dependent Pulmonary Circulation

“… 22 In addition, the re-intervention rate is more closely related to the morphology of the duct and is similar between univentricular and biventricular hearts. 23 The current study found that the re-intervention rate was 33%, similar to the previous finding reported in the literature. In our center, cardiac catheterisation post-PDA stenting is not done electively at defined intervals; it is usually performed when patients have worsening cyanosis or when there is a significant stenosis of the PDA stent observed by echocardiography.…”

A rare complication after an interventional procedure using the common carotid: carotid pseudoaneurysm in an infant

“…Arterial access was gained via the common carotid artery in 14 patients, and no patient developed a pseudoaneurysm. 6 Pseudoaneurysm develops after damage to the arterial wall, with a permanent connection between the artery and the cavity formed outside the vessel. It differs from true aneurysm by not participating in the formation of the three layers of the arterial wall.…”

Carotid artery cut-down technique for ductus arteriosus stenting

“…Ductal stenting has offered an alternative to surgery in suitable patients with ductal-dependent pulmonary circulation in recent years. [3][4][5][6][7][8] However, patients' low body weight and vertical or tortuous anatomy of the ductus present challenges while attempting ductal stenting via the femoral approach. Surgical carotid cut-down-assisted cardiac catheterization was first described as an alternative route by Azzolina et al [13] in 1973.…”

“…Currently, ductal stenting is the first treatment of choice for initial palliation in many centers. [3][4][5] Femoral access is the standard approach for ductal stenting. Yet, it may be challenging in some cases, particularly those with vertical and tortuous ductal anatomy.…”