Comparison of pulmonary artery growth between ductus stent and systemic-to-pulmonary shunt as single-ventricle palliation

IF 4.4 1区医学 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS Journal of Thoracic and Cardiovascular Surgery Pub Date : 2024-10-03 DOI:10.1016/j.jtcvs.2024.09.047

Dimitrij Grozdanov MS , Nicole Piber MD , Kristina Borgmann MD , Thibault Schaeffer MD , Takuya Osawa MD , Jonas Palm MD , Carolin Niedermaier MS , Paul Philipp Heinisch MD, PhD , Stanimir Georgiev MD, PhD , Alfred Hager MD, PhD , Peter Ewert MD, PhD , Jürgen Hörer MD, PhD , Masamichi Ono MD, PhD

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Abstract

Objective

We aimed to compare the pulmonary artery (PA) growth between infants with univentricular hearts who underwent a ductus stenting (DS) and those who received a systemic to pulmonary shunt (SPS) as an initial palliation.

Methods

All infants with ductal-dependent pulmonary blood flow who underwent initial palliation with either a DS or SPS between 2009 and 2022 in our institution were reviewed. PA development was compared between the groups using the PA index and the symmetry index.

Results

A total of 130 patients were evaluated including 49 patients after DS and 81 after SPS. The most frequent primary diagnosis was tricuspid atresia in 27, followed by pulmonary atresia with intact ventricular septum in 19. At stage II palliation, PA index (P = .926), right PA index (P = .692), left PA index (P = .297), and the symmetry index (P = .650) were similar between the groups. At stage III Fontan completion, PA index (P = .115), right PA index (P = .868), and the symmetry index (P = .144) were similar between the groups. However, left PA index (60 vs 74 mm²/m²; P = .015) was lower, and the incidence of venovenous collaterals (24.2% vs 7.8%; P = .036) was higher in the DS group compared with the SPS group. Freedom from PA interventions between stage II and III palliation was lower in the DS group compared with the SPS group (P = .009).

Conclusions

In infants with univentricular heart after DS, freedom from PA interventions after stage II was lower and the left PA index was smaller, compared with those after SPS. Long-term outcomes after the Fontan procedure should be addressed in patients after DS.

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作为单心室姑息治疗方法，比较导管支架和全身-肺分流术的肺动脉生长情况。

目的：我们的目的是比较接受动脉导管支架植入术（DS）和全身至肺分流术（SPS）作为初始姑息治疗的单室心婴儿的肺动脉（PA）生长情况：方法：回顾性分析我院 2009 年至 2022 年期间接受 DS 或 SPS 作为初始姑息治疗的所有导管依赖性肺血流的婴儿。使用 PA 指数和对称性指数比较两组之间的 PA 发育情况：结果：共对130名患者进行了评估，包括49名DS术后患者和81名SPS术后患者。最常见的主要诊断是三尖瓣闭锁（27 例），其次是肺动脉闭锁伴室间隔完整（19 例）。在二期姑息治疗时，两组的PA指数（P=0.926）、右PA指数（P=0.692）、左PA指数（P=0.297）和对称性指数（P=0.650）相似。在第三期Fontan手术完成时，两组的PA指数（p=0.115）、右PA指数（p=0.868）和对称指数（p=0.144）相似。然而，DS组的左侧PA指数（60 vs. 74mm2/m2，p=0.015）低于SPS组，静脉袢的发生率（24.2 vs. 7.8%，p=0.036）高于SPS组。与SPS组相比，DS组在II期和III期姑息治疗期间的PA干预自由度较低（P=0.009）：结论：与SPS术后患者相比，单心室婴儿DS术后第二阶段PA干预自由度较低，左侧PA指数较小。应关注DS患者丰坦术后的长期预后。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Journal of Thoracic and Cardiovascular Surgery 医学-呼吸系统

CiteScore

11.20

自引率

10.00%

发文量

1079

审稿时长

68 days

期刊介绍： The Journal of Thoracic and Cardiovascular Surgery presents original, peer-reviewed articles on diseases of the heart, great vessels, lungs and thorax with emphasis on surgical interventions. An official publication of The American Association for Thoracic Surgery and The Western Thoracic Surgical Association, the Journal focuses on techniques and developments in acquired cardiac surgery, congenital cardiac repair, thoracic procedures, heart and lung transplantation, mechanical circulatory support and other procedures.