Outcome of Interventional Stenting of the Patent Ductus Arteriosus in Neonates with Duct-Dependent Pulmonary Perfusion

Objectives: We aimed to assess the outcome of neonates with cyanotic heart defects and duct-dependent pulmonary perfusion who received interventional PDA stenting as first-line therapy to avoid an operation in the neonatal period.

Methods: Retrospective, single-center case review evaluating 26 patients (65% males) with duct-dependent pulmonary perfusion (15 pulmonary atresia, 5 TOF, and 6 various) who received PDA stenting between January 2013 and November 2019.

Result: Median age at stenting was 10 ± 9 days and body weight 3.3 ± 0.5 kg. A total of 24 (92%) patients received prostaglandin prior to stenting; in 19 (73%), pulmonary perfusion was completely duct dependent. Overall, 27% had an atypical duct location with 65% having a tortuous duct morphology. Diameter of PDA was 2.56 ± 0.86 mm. Vascular access was primarily established retrograde via femoral artery (n = 18, 69%). Also, 2.1 ± 0.9 balloon-dilatable stents were implanted per patient. In 23 (88%) patients, PDA stent was placed successfully (stent diameter: 3.6 ± 0.4, IQR: 3.5–4 mm). Two stents dislocated into the pulmonary artery, in another patient, LPA perfusion was reduced postprocedurally due to “pulmonary coarctation.” All three patients needed early surgical stent removal and shunt placement or RVOT patch enlargement. No periprocedural death occurred. Postprocedural 30-day mortality was 4% (n = 1) at 14 days. Another patient died 52 days postprocedural. In both patients, death most probably was not related to stent thrombosis. Patients received postprocedural anticoagulation therapy with LMW heparin in 21 (81%), it was changed to aspirin (after 8.3 ± 13.6 days). During follow-up, one patient needed an additional surgical shunt 14 days after PDA stenting due to cyanosis. Five (22%) patients received transcatheter reintervention 26 ± 12 days after PDA stenting to assure adequate pulmonary perfusion (stent redilatation and/or restenting). Including those with reintervention, 20 (77%) patients successfully achieved time and weight gain until the first surgical procedure: 6 patients with univentricular hearts received Glenn's operation 129 ± 71 days after PDA stenting, 12 patients biventricular surgical repair after 78 ± 43 days, and 2 patients 1.5-chamber correction after 601 ± 39 days.

Conclusion: Neonatal PDA stenting to secure pulmonary perfusion appears to be safe and feasible, even in complex PDA morphology. In more than 75% of the patients with either uni- or biventricular heart morphology, the first surgical intervention could be postponed as desired. Interventional PDA stenting can replace surgical shunt placement in eligible patients.

Publication History

Article published online:
21 February 2021