Short- and medium-term outcomes for patent ductus arteriosus stenting in neonates ≤2.5 kg with duct-dependent pulmonary circulation.
Nasef MA, Shahbah DA, Batlivala SP, Darwich R, Qureshi AM, Breatnach CR, Linnane N, Walsh KP, Oslizlok P, McCrossan B, Momenah T, Alshahri A, Abdulhamed J, Arafat A, Tamimi OA, Diraneyya OM, Goldstein BH, Kenny D. Catheter Cardiovasc Interv. 2022 Oct;100(4):596-605. doi: 10.1002/ccd.30351. Epub 2022 Jul 29.PMID: 35904221
Take Home Points:
1) Stenting the patent ductus arteriosus in infants ≤ 2.5 kg with DDPBF is technically feasible and achieves short-term outcomes comparable to or better than surgical systemic-to-pulmonary shunting.
2) There is relatively high incidence of morbidity with this procedure, especially related to arterial access.
Commentary from Dr. Konstantin Averin (Cohen Children’s Heart Center), catheterization section editor of Pediatric Cardiology Journal Watch:
Stenting of the patent ductus arteriosus (PDA) has become an accepted alternative to a surgical systemic-to-pulmonary shunting (SPS) in patients with ductal dependent pulmonary blood flow DDPBF). Infants who are ≤ 2.5 kg are at highest risk for SPS, so PDA stenting is an attractive option in this patient population. The authors sought to assess procedural and short-term outcomes in infants ≤ 2.5 kg undergoing PDA stenting for DDPBF using data from 4 large cardiac centers.
From March 2007 to February 2020, 38 patients – median age at procedure 10 days (IQR 6-15), median procedural weight 2.2 kg (IQR 2-2.4 kg) (11 under 2.0kg) – underwent PDA stenting. There were a variety of diagnoses, but a majority had pulmonary atresia or pulmonary stenosis (71%). A majority (79%) of the PDA’s had complex anatomy with a tortuosity index of II or III. In 47% of patients the procedure was performed via the femoral artery, while the carotid artery was used in 8 (21%), umbilical artery in 6, axillary artery in 4, and femoral vein in 2 (Figure 1).
Patient outcomes are summarized in Figure 3. Successful stent implant was achieved in 92% of initial procedures (35/38) with no procedural deaths. There was a high incidence (18%, 7/38) of serious adverse events related to the primary procedure (Figure 2) – most commonly related to carotid and femoral artery access. The thirty-day survival for the entire cohort was 97%. Twenty patients required reintervention.
The authors conclude that PDA stenting in infants ≤ 2.5 kg is feasible and effective. The authors should be commended for providing important data on a challenging procedure in a very challenging patient population. Despite the relatively high risk of access related complications, it is interesting that none of the patients who underwent axillary artery access had any complications related to this. Recognizing that this was one of the access sites used least frequently further investigation as to whether the axillary artery may be a safer approach for this procedure is warranted. This study highlights the need for additional data to inform decision making around PDA stenting.