Background
Transcatheter stenting of the ductus arteriosus (DA) is a palliation strategy for ductal-dependent pulmonary blood flow (PBF). This study aims to develop a Technical Performance Score (TPS) to assess procedural success and validate it with retrospective single-center outcome data.
Methods
The TPS was developed based on consensus opinion amongst pediatric cardiologists experienced in DA stenting. The TPS is based on 3 categories: procedural technique focusing on ductal dissection, thrombosis or stent embolization; stent position focusing on ductal coverage and pulmonary artery jailing; and vascular access. Each category is scored 0 to 3 with an optimal score being 9. All patients considered for DA stenting from 2002-2021 at Seattle Children’s Hospital were evaluated. Clinical data and angiography were independently reviewed and scores were assigned. Patients were grouped by score: high (7,8,9), medium (4,5,6) and low (0,1,2,3). Clinical outcomes for each group were compared through the initial surgical intervention.
Results
118 patients were identified; 84% had a stent implanted with 78% successful. 70 patients received a high score, 25 medium and 23 low. There was no difference in procedural weight between groups (p=0.69)
. Severe ductal tortuosity was more common in the low score group (57% vs 22%, p=0.005). Major procedural adverse events occurred in 5 patients; 1 requiring ECMO due to ductal dissection, 4 requiring CPR for arrythmia and no procedural deaths. A low score was more likely to undergo surgery during first hospitalization compared to the other groups (87% vs 9.5%, p<0.001). Time to surgical intervention was shorter in the low score group (24 days) compared to the medium (286 days) and high score (162 days) groups (p<0.001). There were 5 mortalities prior to next palliative surgery with no difference between groups, all occurred after 6 days post-intervention.
Conclusions
A low TPS was more commonly seen in cases of unsuccessful DA stenting in patients with more complex ductal anatomy who ultimately required earlier surgical intervention compared to patients with higher scores. This study suggests that the TPS can be used as a tool to evaluate the effect of procedural performance on clinical outcomes in DA stenting.