Pediatric and Congenital Cardiac Surgery Unit, University of Padua, Padua, Italy.
Ann Thorac Surg. 2010 Aug;90(2):605-9. doi: 10.1016/j.athoracsur.2010.04.007.
Stenting of the patent ductus arteriosus (PDA) has been recently introduced to palliate patients with duct-dependent pulmonary circulations. We evaluated the surgical outcome of patients who had a previous PDA stent, focusing on their pulmonary arteries status.
This study included 15 patients (11 boys, 4 girls) who underwent cardiac operations after PDA stenting between August 2004 and April 2009. Outcomes included hospital mortality, morbidity, and need for reintervention or operation on the PDA and on the pulmonary artery branches.
Thirteen patients underwent elective cardiac operations at a median of 11 months (range, 0.3 months to 3.7 years) from PDA stenting. Two patients underwent emergency operations due to stent migration during percutaneous positioning. Six patients (46%) required a preoperative interventional cardiology procedure, including PDA stent dilatation in 5 and multiple left pulmonary artery dilatations in 1. During elective surgical repair, PDA stents were completely retrieved in 3 patients (23%) and partially removed in 10 (77%) due to the fusion of the stent to the vascular wall. Seven patients (53.8%) required surgical pulmonary artery plasty. One in-hospital death (6%) occurred after an emergency operation. Median follow-up was 16.7 months (range, 1 month to 2.5 years). Two late deaths (14%) occurred at 4 and 9 months. Four patients required additional interventional procedures on the left pulmonary artery after surgical repair.
Operations after PDA stenting are safe and low-risk. The presence of PDA stents requires additional surgical maneuvers on pulmonary arteries in near half of the patients, and postoperative interventions can be required.
最近，支架置入术已被应用于治疗依赖动脉导管未闭（PDA）的肺循环障碍患者。我们评估了 15 例在 PDA 支架置入术后接受心脏手术患者的手术结果，重点关注其肺动脉情况。
这项研究纳入了 2004 年 8 月至 2009 年 4 月间接受 PDA 支架置入术后接受心脏手术的 15 例患者（11 名男性，4 名女性）。研究结果包括院内死亡率、发病率、PDA 和肺动脉分支再干预或手术的需求。
13 例患者在 PDA 支架置入后中位时间 11 个月（范围 0.3 个月至 3.7 年）行择期心脏手术。2 例患者因经皮定位时支架移位而行急诊手术。6 例（46%）患者需要术前介入心脏病学操作，包括 5 例 PDA 支架扩张和 1 例左肺动脉多处扩张。在择期手术修复中，3 例（23%）患者完全取出 PDA 支架，10 例（77%）患者因支架与血管壁融合而部分取出。7 例（53.8%）患者需要行肺动脉整形术。1 例（6%）患者在急诊手术后院内死亡。中位随访时间 16.7 个月（范围 1 个月至 2.5 年）。2 例（14%）患者在术后 4 个月和 9 个月死亡。4 例患者在手术后需要对左肺动脉进行额外的介入治疗。
PDA 支架置入术后的手术是安全和低风险的。近一半的患者需要对 PDA 支架进行额外的肺动脉手术操作，术后可能需要进行干预。
