Children Health Ireland at Crumlin, Dublin, Ireland.
Prince Sultan Cardiac Center, Riyadh, Kingdom of Saudi Arabia.
Catheter Cardiovasc Interv. 2022 Oct;100(4):596-605. doi: 10.1002/ccd.30351. Epub 2022 Jul 29.
Morbidity with surgical systemic-to-pulmonary artery shunting (SPS) in infants ≤2.5 kg has remained high. Patent ductus arteriosus (PDA) stenting may be a valid alternative. The objective of this study is to evaluate outcomes following PDA stenting in patients ≤2.5 kg from four large tertiary centers.
Retrospective review of all neonates ≤2.5 kg with duct-dependent pulmonary circulation who underwent PDA stenting. Procedural details, pulmonary arterial growth, reinterventions, surgery type, and outcomes were assessed.
PDA stents were implanted in 37 of 38 patients attempted (18 female) at a median procedural weight of 2.2 kg (interquartile range [IQR], 2-2.4 kg). Seven patients (18%) had a genetic abnormality and 16 (42%) had associated comorbidities. The median intensive care unit stay was 4 days (IQR, 2-6.75 days), and the median hospital stay was 20 days (IQR, 16-57.25). One patient required a rescue shunt procedure, with three others requiring early SPS (<30 days postprocedure). Twenty patients (54%) required reintervention with either balloon angioplasty, restenting, or both. At 6-month follow-up, right pulmonary artery growth (median z-score -1.16 to 0.01, p = 0.05) was greater than the left pulmonary artery (median z-score -0.9 to -0.64, p = 0.35). Serious adverse effects (SAEs) were seen in 18% (N = 7) of our cohort. One patient developed an SAE during planned reintervention There were no intraprocedural deaths, with one early procedure-related mortality, and three interstage mortalities not directly related to PDA stenting.
PDA stenting in infants ≤2.5 kg is feasible and effective, promoting pulmonary artery growth. Reintervention rates are relatively high, though many are planned to allow for optimal growth before a definitive operation.
体重≤2.5kg 的婴儿进行外科体肺动脉分流术（SPS）相关的发病率仍然很高。动脉导管未闭（PDA）支架置入术可能是一种有效的替代方法。本研究的目的是评估四家大型三级中心≤2.5kg 的患者行 PDA 支架置入术的结果。
回顾性分析所有依赖导管循环的≤2.5kg 新生儿行 PDA 支架置入术的患者。评估了手术细节、肺动脉生长、再干预、手术类型和结局。
38 例患者中，37 例（18 例女性）成功实施 PDA 支架置入术（2.2kg 为中位数，四分位距 [IQR]，2-2.4kg）。7 例（18%）存在遗传异常，16 例（42%）存在合并症。中位数 ICU 住院时间为 4 天（IQR，2-6.75 天），中位数住院时间为 20 天（IQR，16-57.25 天）。1 例患者需要抢救分流术，另有 3 例患者需要早期 SPS（<30 天）。20 例（54%）患者需要再次介入治疗，包括球囊血管成形术、再次支架置入或两者兼有。在 6 个月的随访中，右肺动脉生长（中位数 z 评分-1.16 至 0.01，p=0.05）大于左肺动脉（中位数 z 评分-0.9 至-0.64，p=0.35）。我们的队列中有 18%（N=7）的患者出现严重不良事件（SAE）。1 例患者在计划再次介入治疗时发生 SAE。术中无死亡，1 例早期与手术相关的死亡率，3 例围手术期死亡率与 PDA 支架置入术无关。
体重≤2.5kg 的婴儿行 PDA 支架置入术是可行且有效的，可促进肺动脉生长。再干预率相对较高，但许多都是为了在进行确定性手术之前使血管充分生长而计划进行的。
