Stent implantation of the arterial duct in newborns with a truly duct-dependent pulmonary circulation: a single-center experience with emphasis on aspects of the interventional technique.

ABSTRACT

INTRODUCTION: Ductal stenting for pulmonary blood supply in newborns with cyanotic congenital heart disease (CHD) might be a low risk and safe alternative to the surgical aorto-to-pulmonary artery (AP) shunt in dual-source lung perfusion. Ductal stenting in truly duct-dependent pulmonary circulation has not been evaluated. METHODS: Prospective interventional and clinical follow-up trial. Ductal stenting based on variable access sites, a 2-wire technique when crossing a tortuous ductus, and use of premounted coronary stents. Primary outcome measures were procedural success and complication rates presented as early and mid-term results. RESULTS: From 2003-2009, 58 duct-dependent newborns underwent ductal stenting; 27 of them were truly duct dependent, 20 had pulmonary atresia (PA)/ventricular septum defect or complex CHD, 4 had PA/intact ventricular septum, 2 had PA with Ebstein anomaly, and 1 had PA with tricuspid atresia. Ductal stenting was performed without procedure-related mortality; 3 of 27 required an acute surgical AP-shunt (stent migration in 1, acute duct obstruction in 2). During mid-term follow-up, 4 of 24 needed an AP-shunt and two others stent redilation. Three patients died prior to follow-up surgery (1 unexpectedly at home and 2 due to syndromatic disease). Fifteen patients received staged univentricular palliation, 8 had a biventricular repair, and 1 is awaiting follow-up operation. CONCLUSION: Ductal stenting is a feasible, safe, and effective palliation in newborns with truly duct-dependent pulmonary circulation irrespective of duct morphology. Vasucular access from various locations is important for technical success rate. Ductal stenting is a minimally invasive procedure to achieve adequate pulmonary artery growth for subsequent palliative or corrective surgery.