Stenting the arterial duct in neonates and infants with congenital heart disease and duct-dependent pulmonary blood flow: a multicenter experience of an evolving therapy over 18 years.

OBJECTIVES: The primary aim of this multi-institutional study was to describe our 18-year experience of ductal stenting (DS) in infants with a duct-dependent pulmonary circulation. The secondary aim sought to identify a subgroup of patients who may benefit the most using this evolving technique.
BACKGROUND: No study has examined the extraordinary evolution of this promising therapy over the last two decades.
METHODS: Between 1991 and 2009, 65 neonates and infants (39 male, 60%) underwent cardiac catheterization for DS in 3 participating centres. Patients were divided according to whether DS was attempted between 1991-2000 (Group 1, n = 20) or between 2001-2009 (Group 2, n = 45).
RESULTS: DS was successful in 52/65 (80%) patients. DS outcome was associated with ductal morphology and cardiac diagnosis. DS failed more often in patients with univentricular physiology and tortuous duct morphology (p < 0.001). Most patients undergoing DS in Group 2 had pulmonary atresia with intact ventricular septum (PAIVS) (p < 0.001). DS was successful in 94% of these patients. Groups differed significantly in diameter and length of first implanted stent (p < 0.001), implanting additional stent (p < 0.001), and occurrence of complications (p = 0.033). Freedom from re-intervention for the 52 patients was 92.3%. No procedure-related mortality occurred.
CONCLUSIONS: The technical aspects and clinical application of percutaneous DS has changed in the last two decades. DS has become a practical and safe therapy in a subgroup of neonates with ductal-dependent pulmonary blood flow.