TY - JOUR
T1 - Impact of preoperative left pulmonary artery stenting on the Fontan procedure
T2 - a retrospective multicentre study
AU - Comentale, Giuseppe
AU - Cucchi, Marta
AU - Serrao, Andrea
AU - Careddu, Lucio
AU - Napoleone, Carlo Pace
AU - Gargiulo, Gaetano
AU - Oppido, Guido
N1 - Publisher Copyright:
© The Author(s) 2024. Published by Oxford University Press on behalf of the European Association for Cardio-Thoracic Surgery. All rights reserved.
PY - 2024/2/1
Y1 - 2024/2/1
N2 - OBJECTIVES: Left pulmonary artery (LPA) or bifurcation stenoses at Fontan palliation can be very challenging to treat and may also require cardioplegia and aortic transection. Moreover, the low pressure of Fontan circulation and the bulkiness of the aorta increase the risk of a patch angioplasty collapse. Pre-Fontan LPA stenting of stenotic LPAs overcomes those drawbacks therefore the present study aimed to evaluate its advantageous impact on Fontan surgery. METHODS: A multicentre retrospective analysis was performed on 304 consecutive Fontan patients. The study population was divided into 2 groups (LPA stented, n?=?62 vs not stented, n?=?242); pre-and postoperative data were compared. RESULTS: LPA-stented patients had a higher prevalence of systemic right ventricle (P?=?0.01), hypoplastic left heart syndrome (P?=?0.042), complex neonatal palliations (Norwood/Damus-Kaye-Stansel) and surgical LPA patch repair at Glenn (P?<?0.001). No differences were found in cross-clamp rates, early (P?=?0.29) and late survival (94.6% vs 98.4, P?=?0.2) or complications (P?=?0.14). Complex palliations on ascending aorta/aortic arch (P?=?0.013) and surgical LPA repair at Glenn (P?<?0.001) proved to be risk factors for LPA stenting before Fontan at multivariable analysis. CONCLUSIONS: The LPA-stented group showed similar outcomes in terms of survival and complications rate compared to patients without LPA stenosis; however, they significantly differ in their higher preoperative risk profile and in their more complex anatomy. Complex neonatal palliations involving ascending aorta or aortic arch may increase the risk of pulmonary branches stenosis requiring stenting; therefore, preoperative stenting of LPA stenoses could help to reduce the surgical risk of complex Fontan procedure by avoiding the need for cross-clamp or complex mediastinal dissections to perform a high-risk surgical repair.
AB - OBJECTIVES: Left pulmonary artery (LPA) or bifurcation stenoses at Fontan palliation can be very challenging to treat and may also require cardioplegia and aortic transection. Moreover, the low pressure of Fontan circulation and the bulkiness of the aorta increase the risk of a patch angioplasty collapse. Pre-Fontan LPA stenting of stenotic LPAs overcomes those drawbacks therefore the present study aimed to evaluate its advantageous impact on Fontan surgery. METHODS: A multicentre retrospective analysis was performed on 304 consecutive Fontan patients. The study population was divided into 2 groups (LPA stented, n?=?62 vs not stented, n?=?242); pre-and postoperative data were compared. RESULTS: LPA-stented patients had a higher prevalence of systemic right ventricle (P?=?0.01), hypoplastic left heart syndrome (P?=?0.042), complex neonatal palliations (Norwood/Damus-Kaye-Stansel) and surgical LPA patch repair at Glenn (P?<?0.001). No differences were found in cross-clamp rates, early (P?=?0.29) and late survival (94.6% vs 98.4, P?=?0.2) or complications (P?=?0.14). Complex palliations on ascending aorta/aortic arch (P?=?0.013) and surgical LPA repair at Glenn (P?<?0.001) proved to be risk factors for LPA stenting before Fontan at multivariable analysis. CONCLUSIONS: The LPA-stented group showed similar outcomes in terms of survival and complications rate compared to patients without LPA stenosis; however, they significantly differ in their higher preoperative risk profile and in their more complex anatomy. Complex neonatal palliations involving ascending aorta or aortic arch may increase the risk of pulmonary branches stenosis requiring stenting; therefore, preoperative stenting of LPA stenoses could help to reduce the surgical risk of complex Fontan procedure by avoiding the need for cross-clamp or complex mediastinal dissections to perform a high-risk surgical repair.
KW - Fontan
KW - Norwood
KW - Pulmonary artery stenosis
KW - Pulmonary artery stenting
KW - Single ventricle
U2 - 10.1093/ejcts/ezae035
DO - 10.1093/ejcts/ezae035
M3 - Article
SN - 1010-7940
VL - 65
JO - European Journal of Cardio-Thoracic Surgery
JF - European Journal of Cardio-Thoracic Surgery
IS - 2
M1 - ezae035
ER -