Stage 1 and 2 Palliation: Comparing Ductal Stenting and Aorto-Pulmonary Shunts in Single Ventricles with Duct-Dependent Pulmonary Blood Flow - PubMed (original) (raw)

Stage 1 and 2 Palliation: Comparing Ductal Stenting and Aorto-Pulmonary Shunts in Single Ventricles with Duct-Dependent Pulmonary Blood Flow

Srujan Ganta et al. Pediatr Cardiol. 2024 Mar.

Abstract

Patent ductus arteriosus stenting (PDAS) for ductal-dependent pulmonary blood flow (DDPBF) provides a new paradigm for managing neonates with single ventricles (SV). Currently, sparse data exist regarding outcomes for subsequent palliation. We describe our experience with inter-stage care and stage 2 (S2P) conversion with PDAS in comparison to a prior era of patients who received surgical aorto-pulmonary shunts (APS). Retrospective review of 18 consecutive DDPBF SV patients treated with PDAS between 2016 and 2021 was done and compared with 9 who underwent APS from 2010 to 2016. Patient outcomes and pulmonary artery (PA) growth were analyzed. S2P was completed in all 18 with PDAS with no cardiac arrests and one post-S2P mortality. In the 9 APS patients, there was one cardiac arrest requiring ECMO and one mortality inter-stage. Off cardiopulmonary bypass strategy was utilized in 10/18 in the PDAS and 1/9 in the APS group (p = 0.005) at S2P. Shorter ventilation time, earlier PO feeding, and shorter hospital stay were noted in the PDAS group (p = 0.01, p = 0.006, p = 0.03) (S2P). Median Nakata index increase inter-stage was not significant between the PDAS and APS at 94.1 mm2/m2 versus 71.7 mm2/m2 (p = 0.94). Median change in pulmonary artery symmetry (PAS) was - 0.02 and - 0.24, respectively, which was statistically significant (p = 0.008). Neurodevelopmental outcomes were better in the PDAS group compared to the APS group (p = 0.02). PDAS provides excellent PA growth, inter-stage survival, progression along multistage single-ventricle palliation, and potentially improved neurodevelopmental outcomes. Most patients can be transitioned through 2 stages of palliation without CPB.

Keywords: Bi-directional Glenn; Cavo-pulmonary connection; Ductal stenting; Neurocognitive deficits; PDA stenting; Single ventricles.

© 2024. The Author(s).

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Conflict of interest statement

The authors declare no competing interests.

Figures

Fig. 1

Fig. 1

Left axillary approach to ductal stenting. Inset image depicts stent deployment in the PDA

Fig. 2

Fig. 2

Right-sided Glenn construction with PDAS in the Main pulmonary artery utilizing and SVC-Right atrial shunt

Fig. 3

Fig. 3

Homograft patch reconstruction of branch pulmonary arteries off cardiopulmonary bypass

Fig. 4

Fig. 4

Feeding strategy post-S1P for PDAS and APS patients

Fig. 5

Fig. 5

Nakata indexes for patients at S1P and S2P for both PDAS and APS demonstrating pulmonary artery growth interstage. The listed p-values indicate the growth in both groups of patients was significant inter-stage. The difference in growth between PDAS and APS however was not significant as listed in our data tables

Fig. 6

Fig. 6

Change in WAZ (weight for age _z_-score) from birth to present follow-up. Superimposed line graph represents mean WAZ as followed through stages. The upper and lower limits of the green boxes represent the first (Q1) and third (Q3) quartiles. The line in the box represents medians, while the whiskers represent minimum and maximum values. There was a significant difference between WAZ for the 2 groups at follow-up

References

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