Outcomes and Risk Factors of Stenting the Ductus Arteriosus in Infants with Duct-Dependent Pulmonary Blood Flow

Objectives: Infants with duct-dependent pulmonary blood flow often undergo palliation with a systemic-pulmonary shunt. However, this procedure is associated with postprocedural instability and potential for morbidity and mortality. Stenting of the ductus arteriosus (DA) is an emerging alternative but with limited data about outcomes and risk factors due to small patient numbers. Thus, aim of the study was to determine outcome and risk factors of stenting the DA.

Methods: All patients who underwent stenting of the DA between 2013 and 2020 were included in the study. A classification scheme of duct morphology was developed: type 1: straight, type 2: curved, type 3: one turn, and type 4: multiple turns. The type of DA was determined, as well as the diameters of left and right pulmonary artery (LPA and RPA, respectively) before intervention and next-step surgery (NSS).

Result: Seventy-six patients were included in the study. Median age and median weight at DA stenting were 7 days (IQR: 4; 14 days) and 3,022 g (IQR: 2.677–3.455 g), respectively. Single ventricle physiology was found present in 39%. Antegrade pulmonary blood flow was present in 64%. In 18 patients, stenting of the DA was not possible (n = 6) due to technical or morphological reasons or a shunt implantation became necessary after stent implantation (n = 12). Survival was 95 ± 2.7 and 90 ± 3.6% at 60 days and 1 year, respectively. Freedom from reintervention was 80 ± 5.2% after 30 days of implantation. Complex anatomy of the ductus (type IV) is a risk factor for failure of implantation (p = 0.004) and for reintervention (p = 0.008). Patch plasty of the PA was performed in 70% of the patients at the NSS. Ostial LPA stenosis was present in 19% before intervention and its incidence increased to 38% (p = 0.038) at NSS, whereas the incidence of ostial RPA stenosis increased from 2.3 to 9.5% (p = 0.197). RPA and LPA exhibited symmetric growth: The ratio of RPA/LPA did not differ before intervention and NSS and was at 1.1.

Conclusion: DA stenting in patients with duct-dependent pulmonary blood flow is a valuable alternative to surgical shunts. Morphology of the DA, however, is a risk factor for failure and reintervention. LPA stenosis has to be frequently addressed at NSS. Further studies need to compare these results with the surgical approach.

Publication History

Article published online:
21 February 2021