B-13 | Short and Mid-Term Outcomes of Patients Undergoing Arterial Duct Stenting in Duct Dependent Pulmonary Circulation

Duct stenting is an alternate to surgical shunt as a palliation to establish of good pulmonary blood flow (PBF) in children with duct dependent PBF. Duct dependent hypoxic patients (Arterial oxygen saturation, SO2 < 80%) with pulmonary atresia, a restrictive duct supplying confluent pulmonary artery (PA) branches underwent duct stenting and were studied prospectively. Sixty patients with 12 (1-1095) days age and 2.8 (2.2-8.9) kg weight were posted. Associations were ventricular septal defect (VSD) in 22, double outlet right ventricle in 13, tricuspid atresia in 12, intact ventricular septum in 10 and others in 3. Baseline SO2 was 68.9 ± 7.5%. Z score of right PA (RPA) was -1.2 (-10.5 to 2.8) and left PA (LPA) was -0.9 (-8.0 to 3.0). PA hypoplasia was unilateral in 25 or bilateral in 8. Nine had branch PA stenosis. Narrowest duct diameter was 1.7 ± 0.6 mm. Length was 12.8 ± 3.3 mm. Origin was vertical underneath the arch in 35 and from the proximal descending aorta in 25. Shape was U in 4, tortuous in 35, straight tubular in 5 or conical in 16. Approach was retrograde from femoral artery in 28, axillary artery in 5 or antegrade from femoral vein via a VSD in 27. Catheters used were Judkins right in 42 or Internal Mammary artery in 18. Mullins sheath was used in 29. A floppy wire was replaced with an extra support one in 19. Sixty four stents with 4.2 ± 0.3 mm diameter and 14.3 ± 3.4 mm length were deployed within 12 (3-56) minutes. The success was 98.3%. It was 100% with transvenous route. Narrowest duct diameter improved to 3.7 ± 0.7 mm and SO2 improved to 90.4 ± 6.04% from baseline (p<0.001). Complications were pulmonary oedema in 1 and ductal PA end constriction requiring restenting in 1. At 8 (2-14) months; SO2 (80.0 ± 7.5%); RPA Z score, 0.56 (-2.9 to 3.3) and LPA Z score, -0.02 (-2.81 to 3.86), were higher than baseline (p<0.001). Four had PA branch hypoplasia at follow up, vs. 25 at baseline (p<0.0001). At 6 months 3 needed shunt and 3 needed restenting, with a 95.4% freedom from surgical reintervention. At 8 (5-11) months, definitive surgeries were performed in 35. Probable cardiac cause of death was impaired PBF in 3. In patients with duct dependent PBF, duct stenting maintains adequate SO2, balanced PA growth and bridges to definitive surgery.