Factors Influencing Reintervention Following PDA Stent Implantation for Ductal Dependent Pulmonary Blood Flow - Results from the Congenital Catheterization Research Collaborative
Presenter
Shabana Shahanavaz, M.B.B.S., FSCAI, St. Louis Children's Hospital, St. Louis, MO
Shabana Shahanavaz, M.B.B.S., FSCAI, St. Louis Children's Hospital, St. Louis, MO
Keywords: Interventional Management for Neonatal Tetralogy of Fallot (TOF)
Background:
Stenting of the patent ductus arteriosus (PDA) is an established palliative option for infants with ductal dependent pulmonary blood flow (DD-PBF). Following initial palliation, reintervention (RI) on the PDA stent is common but the risk factors have not been characterized.
Objectives: To determine risk factors for RI following PDA stenting in infants with DD-PBF.
Methods:
Infants with DD-PBF palliated with PDA stent between 2008 - 2015 were reviewed within the 4 center Congenital Catheterization Research Collaborative. Rates and risk factors for RI on the stented PDA were reviewed and analyzed utilizing univariate Cox regression.
Results
:
Among 105 infants who underwent successful PDA stenting, 41 (39%) underwent RI of which 8 (20%) were unplanned, and 33 (80%) were planned. RI was angioplasty alone (n = 36, 88%) or new stent placement (n=5, 12%). Median (IQR) time to RI was 2.9 (2.0 – 3.5) months with all but one RI occurring within 6 months of the initial procedure. Univariate risk factors for RI included: number of stents, use of drug eluting stent (DES), single ventricle disease, increased ductal tortuosity, and lack of intervention prior to PDA stent (Table 1).
Conclusions
:
Reintervention is common in infants with DDPBF palliated with PDA stenting. The majority of RI is planned and is associated with both procedural factors and anticipated clinical outcome. Further studies are needed to investigate the specific risk factors for RI in detail.
