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  • Title: Fate of the ductal stent after hybrid palliation for hypoplastic left heart syndrome.
    Author: Baba K, Chaturvedi R, Lee KJ, Caldarone CA, Benson LN.
    Journal: Ann Thorac Surg; 2013 May; 95(5):1660-4. PubMed ID: 23506633.
    Abstract:
    BACKGROUND: Ductal stenting plays a central role in hybrid palliation (with bilateral pulmonary artery [PA] banding) for hypoplastic left heart syndrome (HLHS). The "natural" history of ductal stent is relatively unknown. METHODS: We retrospectively reviewed 37 neonates with HLHS or its variants who underwent hybrid palliation between January 2004 and March 2010. RESULTS: Forty-nine ductal stents were deployed in 37 neonates. A single stent was implanted in 26, 2 in 10, and 3 in 1 neonate at the index procedure. There were 5 neonates (13.5%) who required reintervention on the stent with an additional implant; 4 stents were placed proximally (PA-end) and 1 on the aorta side. No infant required reintervention on the stent if the implant covered from the PA junction to beyond the aortic isthmus. There were 2 infants (5.4%) who developed retrograde arch obstruction. Of the cohort, 9 died before stage II, 1 had a bidirectional cavopulmonary shunt after conversion to a Norwood circulation, and 27 underwent comprehensive stage II. In 24 infants who did not require an additional stent, duct velocity increased during follow-up (p < 0.001). Stent position was altered distally in relation to the anterior border of the trachea with child growth. CONCLUSIONS: The stent should cover the full length of the duct from the PA junction to beyond the arch isthmus to reduce reintervention rates. Such stents tend to have progressive stenosis and move distally with child growth. However, lower body blood flow appears well maintained until the time of a comprehensive stage II repair.
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