Risk Factors and Outcome of Pulmonary Artery Stenting After Bidirectional Cavopulmonary Connection (BDCPC) in Single Ventricle Circulation

Abstract

After bidirectional cavopulmonary connection (BDCPC) central pulmonary arteries (PAs) of single ventricle (SV) patients can be affected by stenosis or even closure. Aim of this study is to compare SV patients with and without PA-stent implantation post-BDCPC regarding risk factors for stent implantation and outcome. Single center, retrospective (2006–2021) study of 136 SV consecutive patients with and without PA-stent implantation post-BDCPC. Patient characteristics, risk factors for PA-stent implantation and PA growth were assessed comparing angiographic data pre-BDCPC and pre-TCPC. A total of 40/136 (29%) patients underwent PA-stent implantation at median (IQR) 14 (1.1–39.0) days post-BDCPC. 37/40 (92.5%) underwent LPA-stenting. Multiple regression analysis showed single LV patients to receive less likely PA-stents than single RV patients (OR 0.41; p = 0.05). Reduced LPA/BSA (mm/m2) and larger diameter of neo-ascending aorta pre-BDCPC were associated with an increased likelihood of PA-stent implantation post-BDCPC (OR 0.89, p = 0.03; OR 1.05, p = 0.001). Stent re-dilatation was performed in 36/40 (89%) after 1 (0.8–1.5) year. Pulmonary artery diameters pre-BDCPC were lower in the PA-stent group: McGoon (p < 0.001), Nakata (p < 0.001). Indexed pulmonary artery diameters increased equally in both groups but remained lower pre-TCPC in the PA-stent group: McGoon (p < 0.001), Nakata (p = 0.009), and Lower Lobe Index (p = 0.003). LPA and RPA grew symmetrically in both groups. Single RV, larger neo-ascending aorta, and small LPA pre- BDCPC are independent risk factors for PA-stent implantation post-BDCPC. Pulmonary artery diameters after PA-stent implantation and stent re-dilatation showed significant growth together with the contralateral side, but the PA-system remained symmetrically smaller in the stent group.

Possible effects of left pulmonary artery stenting in single ventricle patients on bronchial area, lung volume and lung function

“…We have recently investigated the reasons for LPA stenosis and found that patients with a single right ventricle and history of a Norwood I surgery required more frequently LPA stenting, and that the diameter of the reconstructed ascending aorta after DKS anastomosis was an independent risk factor ( 8 ).…”

“…Stenosis of the central pulmonary arteries is frequent and leads to an obstruction and imbalance of pulmonary blood flow (4,5). The left pulmonary artery (LPA) is mainly affected, as it may be compressed by the dilated (neo-)ascending aorta, or be hypoplastic due to a reduced blood flow (6)(7)(8). In these cases, the treatment of choice is percutaneous stent implantation, since it is minimally invasive, and the radial force of the stent permits to overcome external vessel compression (6,7).…”

The Lifesaving Impact of Transcatheter Interventions in the Early Post-Fontan Palliation Period

“…In recent years, our institution has extended the scope of interventions to include the LPA stenting in this patient group before rather than after the Fontan procedure. Also, in the second interstage period, pulmonary artery stent implantation emerges as a reliable and secure procedure, fostering harmonious growth of the pulmonary arteries [11].…”