Necessity and Benefit of Pulmonary Artery Stenting after Bidirectional Cavopulmonary Connection in Single Ventricle Patients

Background: This study aimed to compare the single-ventricle patients with and without PA-stent implantation post-BDCPC in regard to risk factors and pulmonary arterial growth.

Method: Single center, retrospective (2006–2021), longitudinal study on 136 patients (exclusion criteria: congenital abnormalities of the PAs, pulsatile partial CPC, or temporary stent implantation). PA growth was assessed comparing angio-data pre-BDCPC and pre-TCPC.

Results: A total of 40/136 (29%) patients received a PA-stent at median (IQR) 14 (1.1–39) days post-BDCPC. Indications for catheter intervention early after BDCPC surgery were suspected PA stenosis on echo or hemodynamic instability. Main intraprocedural findings were suspected LPA compression from the ascending aorta (16/40, 40%), LPA hypoplasia (12/40, 30%), stenosis of surgical anastomosis (11/40, 27.5%), and RPA torsion (1/40, 2.5%). Thirty-seven of 40 (92.5%) underwent LPA stenting and 3/40 (7.5%; 2 of which with right aortic arch) underwent RPA stenting. Patients with single RV (p = 0.001) or HLHS-complex (p < 0.001) had a higher incidence of stent implantation. Patients without any intervention around stage I (n = 11, p = 0.05) or only central pulmonary banding (n = 24, p = 0.04) had lower incidence of stent implantation. Diameter of ascending aorta/DKS anastomosis prior to BDCPC (p < 0.001) was significantly higher in the PA-stent group. The PA-stent group underwent earlier BDCPC (p = 0.003). Two patients (2/40, 5%) suffered from LPA dissection during stent implantation but, after surgical repair, both recovered well. Stent redilatation was performed in 36/40 (90%) after 1 (0.8–1.5) year. Collective pulmonary artery diameters pre BDCPC were lower in the PA-stent group: McGoon (p < 0.001) and Nakata (p < 0.001). Lower lobe index was lower, but not significant (p = 0.08). Pulmonary artery diameters increased equally in both groups but remained lower pre TCPC in the PA-stent group: McGoon (p < 0.001), Nakata (p = 0.009), and lower lobe Iindex (p = 0.003). LPA and RPA grew symmetrically in both groups.

Conclusion: PA-stent implantation early after BDCPC is feasible and safe. Patients with a single RV (specifically HLHS complex) are at risk for secondary PA-stent implantation. Significantly larger ascending aorta/DKS anastomosis seems to be an important anatomic feature for potential LPA compression. Since more patients in the stent group had an early BDCPC, this seems to negatively affect PA growth. Fortunately, pulmonary artery diameters after PA stent and stent dilatation showed significant growth together with the contralateral side but the PA system remained symmetrically smaller in the stent group.

Publication History

Article published online:
12 February 2022