Transition to Ductal Stenting for Single Ventricle Patients Led to Improved Survival: An Institutional Case Series

Abstract

Background: The use of systemic-to-pulmonary shunts (SPS) in neonates with single ventricle heart defects and ductal-dependent pulmonary blood flow (ddPBF) was historically associated with high morbidity and mortality at our center. As a result, we transitioned to the preferential use of ductus arteriosus stents (DS) when feasible. This report describes our initial results with this strategy. Methods: A single-center study of single ventricle patients that received DS or SPS from 2015 to 2019 was performed to assess whether DS was associated with decreased in-hospital morbidity and increased survival to stage II palliation. Results: A total of 34 patients were included (DS = 11; SPS = 23). Underlying cardiac anomalies were similar between groups and included pulmonary atresia, unbalanced atrioventricular septal defect, and tricuspid atresia. Procedure success was similar between groups (82% vs 83%). Two DS patients were converted to SPS, due to ductal vasospasm or pulmonary artery obstruction, and four SPS patients required surgical shunt revision. In DS patients, postprocedure mechanical ventilation duration was shorter (one vs three days, P = .009) and fewer required postprocedure extracorporeal membrane oxygenation (9% vs 39%, P = .11). A higher proportion of DS patients survived to stage II palliation (100% vs 64%, P = .035), and the probability of one-year survival was higher in DS patients (100% vs 61%, P = .02). Conclusions: At our center, patients with single ventricle heart defects and ddPBF that received DS experienced reduced in-hospital morbidity and increased survival to stage II palliation compared to SPS.

Stenting of the Patent Ductus Arteriosus: A Meta-analysis and Literature Review

“…For example, among patients with single-ventricle anatomy, Meadows et al 27 mortality, transplant rates, and pulmonary artery growth between stent and shunt groups, although with higher planned reintervention rates in the stent group. Prabhu et al 28 found that PDA stenting was associated with reduced in-hospital morbidity and increased survival to stage II palliation in patients with single-ventricle physiology compared with surgical shunt. Therefore, it seems that for this group of patients, PDA stenting represents a comparable or even superior palliation strategy to surgical shunting.…”

A comparison of ductal stenting and surgical shunts for infants with duct-dependent pulmonary blood flow; the impact of single versus biventricular repair pathways on outcomes.

“…Interstage mortality and unplanned reintervention did not differ between the groups. In contrast, Prabhu et al[9], reporting outcomes in SV infants after DS (n = 11) and BTTS (n = 23), found a higher proportion of survival to stage II surgery after DS (100% versus 64%, p = 0.035). Our data contributes to the evidence that interstage mortality and unplanned re-interventions are similar after DS and BTTS in SV patients.…”