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Preemptive stenting of the left pulmonary artery during Comprehensive Stage 2 procedure does not impact Fontan candidacy

Open AccessPublished:November 25, 2022DOI:https://doi.org/10.1016/j.xjon.2022.11.007
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      Abstract

      Objective

      Pulmonary artery reconstruction during Comprehensive stage 2 (CS2) can be challenging. Since 2017, we have employed preemptive left pulmonary artery (LPA) stenting. We hypothesized that LPA stenting promotes adequate growth and without compromising Fontan candidacy. Herewith, we report our mid-term results.

      Methods

      From 2002 to 2020, 159 patients underwent CS2. Patients were divided as follows: no stent (n=122, Group 1) and perioperative LPA stent (n=37, Group 2). Group 2 was sub-divided according to unplanned stent (2a, n=17) or preemptive stent (2b, n=20). Relevant perioperative data was reviewed. Non-parametric statistics were utilized.

      Results

      Median age and weight at surgery and hospital length of stay after CS2 did not differ between groups. Median cardiopulmonary bypass and crossclamp times were significantly greater in Group 1 (265 v 243 min, p=0.021; 46 v 26 min, p=0.008). In-hospital mortality was similar between groups 1 & 2 (9.0% v 18.9%, respectively, p=0.1348). Group 2b demonstrated a superior survival compared to Group 2a (p=0.0335) but not Group 1 (p>0.9999). Preemptive stenting significantly increased median hilar LPA diameter at CS2 exit angiogram compared to no stenting (p<0.0001). Groups 2a and 2b significantly increased the pre-Fontan diameter of the hilar LPA when compared to Group 1 (6.1 and 6.8 vs 5.7mm, respectively, p<0.0001). A further 120 patients underwent Fontan operation (75%). Median follow-up for Groups 1 and 2 were 7.4 and 3.0 years, respectively.

      Conclusions

      Perioperative LPA stenting during CS2 does not adversely affect pulmonary growth. Preemptive stenting seems advantageous for LPA growth in preparation for Fontan completion.

      Keywords

      Glossary of Abbreviations:

      HLHS (Hypoplastic Left Heart Syndrome), LPA (Left Pulmonary Artery), CS2 (Comprehensive Stage 2), HS1 (Hybrid Stage 1), PA (Pulmonary artery), pRPA (proximal right pulmonary artery), iRPA (interlobar right pulmonary artery), pLPA (proximal left pulmonary artery), hLPA (hilar left pulmonary artery), iLPA (interlobar left pulmonary artery), CPB (cardiopulmonary bypass), mm2 (millimeters squared), m2 (meters squared)