Favourable Short- to Mid-Term Outcome after PDA-Stenting in Duct-Dependent Pulmonary Circulation

Regina Wespi, Alessia Callegari, Daniel Quandt, Jana Logoteta, Michael von Rhein, Oliver Kretschmar and Walter Knirsch ()
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Regina Wespi: Pediatric Cardiology, Pediatric Heart Center, Department of Surgery, University Children’s Hospital Zurich, 8032 Zurich, Switzerland
Alessia Callegari: Pediatric Cardiology, Pediatric Heart Center, Department of Surgery, University Children’s Hospital Zurich, 8032 Zurich, Switzerland
Daniel Quandt: Pediatric Cardiology, Pediatric Heart Center, Department of Surgery, University Children’s Hospital Zurich, 8032 Zurich, Switzerland
Jana Logoteta: Pediatric Cardiology, Pediatric Heart Center, Department of Surgery, University Children’s Hospital Zurich, 8032 Zurich, Switzerland
Michael von Rhein: University of Zurich, 8006 Zurich, Switzerland
Oliver Kretschmar: Pediatric Cardiology, Pediatric Heart Center, Department of Surgery, University Children’s Hospital Zurich, 8032 Zurich, Switzerland
Walter Knirsch: Pediatric Cardiology, Pediatric Heart Center, Department of Surgery, University Children’s Hospital Zurich, 8032 Zurich, Switzerland

IJERPH, 2022, vol. 19, issue 19, 1-14

Abstract: Background. Stenting of patent ductus arteriosus (PDA) is a minimally invasive catheter-based temporary palliative procedure that is an alternative to a surgical shunt in neonates with duct-dependent pulmonary perfusion. Methods. An observational, single-centre, cross-sectional study of patients with duct-dependent pulmonary perfusion undergoing PDA-stenting as a stage I procedure and an analysis of short- to mid-term follow-up until a subsequent surgical procedure (stage II), with a focus on the interstage course. Results. Twenty-six patients were treated with PDA-stenting at a median (IQR) age of 7 (4–10) days; 10/26 patients (38.5%) (6/10 single pulmonary perfusion) were intended for later univentricular palliation, 16/26 patients (61.5%) (13/16 single pulmonary perfusion) for biventricular repair. PDA diameter was 2.7 (1.8–3.2) mm, stent diameter 3.5 (3.5–4.0) mm. Immediate procedural success was 88.5%. The procedure was aborted, switching to immediate surgery after stent embolisation, malposition or pulmonary coarctation in three patients (each n = 1). During mid-term follow-up, one patient needed an additional surgical shunt due to severe cyanosis, while five patients underwent successful catheter re-intervention 27 (17–30) days after PDA-stenting due to pulmonary hypo- ( n = 4) or hyperperfusion ( n = 1). Interstage mortality was 8.6% (2/23), both in-hospital and non-procedure-related. LPA grew significantly ( p = 0.06) between PDA-stenting and last follow-up prior to subsequent surgical procedure ( p = 0.06). RPA Z -scores remained similar ( p = 0.22). The subsequent surgical procedure was performed at a median age of 106 (76.5–125) days. Conclusions. PDA-stenting is a feasible, safe treatment option, with the need for interdisciplinary decision-making beforehand and surgical backup afterwards. It allows adequate body and pulmonary vessel growth for subsequent surgical procedures. Factors determining the individual patient’s course should be identified in larger prospective studies.

Keywords: PDA stenting; univentricular heart; duct-dependent pulmonary circulation; pediatric cardiac interventions (search for similar items in EconPapers)
JEL-codes: I I1 I3 Q Q5 (search for similar items in EconPapers)
Date: 2022
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