Basgoze Serdar, Odemis Ender, Onalan Akif, Temur Bahar, Aydın Selim, Guzelmeric Fusun, Cevik Ayhan, Erek Ersin
Department of Pediatric Cardiovascular Surgery, Acıbadem Mehmet Ali Aydınlar University Atakent Hospital, Istanbul, Türkiye.
Department of Pediatric Cardiology, Koç University Faculty of Medicine, Istanbul, Türkiye.
Turk Gogus Kalp Damar Cerrahisi Derg. 2023 Jul 27;31(3):317-324. doi: 10.5606/tgkdc.dergisi.2023.24598. eCollection 2023 Jul.
This study aims to evaluate early and mid-term outcomes of ductal stenting via carotid artery surgical cut-down technique in neonates.
Between January 2015 and January 2022, a total of 17 neonates (12 males, 5 females; median age: 14 days, range, 5 to 34 days) who underwent carotid artery surgical cut-down technique for ductal stenting were retrospectively analyzed. Diagnoses of the patients, demographics, procedural success/failure, access-related complications, and neuroimaging findings were recorded.
The primary indication for ductal stenting was pulmonary atresia in all patients. All patients who underwent carotid cut-down had vertical anatomy, with or without tortuous ductal anatomy, and they were not suitable for the femoral approach. The median body weight was 3 (range, 2 to 3.4) kg. Fifteen of the 17 interventions (88.2%) were successful. Two patients whose stenting failed underwent a systemic-to-pulmonary shunt operation. The early in-hospital mortality rate was 17.6% (n=3). No neurological or accessrelated complications were observed in any of the patients.
Stenting the ductus arteriosus with challenging anatomy is feasible and safe with carotid artery cut-down, particularly in small neonates. Based on our study findings, this technique may offer an effective and less invasive alternative to the systemic-to-pulmonary shunt operation.
本研究旨在评估经颈动脉手术切开技术对新生儿动脉导管进行支架置入术的早期和中期结果。
回顾性分析2015年1月至2022年1月期间共17例接受颈动脉手术切开技术进行动脉导管支架置入术的新生儿（男12例，女5例；中位年龄：14天，范围为第5至34天）。记录患者的诊断、人口统计学资料、手术成功/失败情况、与穿刺部位相关并发症以及神经影像学检查结果。
所有患者动脉导管支架置入术的主要指征均为肺动脉闭锁。所有接受颈动脉切开术的患者均有垂直走行的解剖结构，无论有无迂曲的动脉导管解剖结构，且均不适合经股动脉途径。中位体重为3（范围为2至3.4）kg。17例介入治疗中有15例（88.2%）成功。2例支架置入失败的患者接受了体肺分流手术。早期院内死亡率为17.6%（n = 3）。未观察到任何患者出现神经或与穿刺部位相关的并发症。
对于解剖结构复杂的动脉导管，采用颈动脉切开术进行支架置入是可行且安全的，尤其是对于小体重新生儿。基于我们的研究结果，该技术可能为体肺分流手术提供一种有效且侵入性较小的替代方法。
