Cardiac operations after patent ductus arteriosus stenting in duct-dependent pulmonary circulation

Background: Stenting of the patent ductus arteriosus (PDA) has been recently introduced to palliate patients with duct-dependent pulmonary circulations. We evaluated the surgical outcome of patients who had a previous PDA stent, focusing on their pulmonary arteries status.

Methods: This study included 15 patients (11 boys, 4 girls) who underwent cardiac operations after PDA stenting between August 2004 and April 2009. Outcomes included hospital mortality, morbidity, and need for reintervention or operation on the PDA and on the pulmonary artery branches.

Results: Thirteen patients underwent elective cardiac operations at a median of 11 months (range, 0.3 months to 3.7 years) from PDA stenting. Two patients underwent emergency operations due to stent migration during percutaneous positioning. Six patients (46%) required a preoperative interventional cardiology procedure, including PDA stent dilatation in 5 and multiple left pulmonary artery dilatations in 1. During elective surgical repair, PDA stents were completely retrieved in 3 patients (23%) and partially removed in 10 (77%) due to the fusion of the stent to the vascular wall. Seven patients (53.8%) required surgical pulmonary artery plasty. One in-hospital death (6%) occurred after an emergency operation. Median follow-up was 16.7 months (range, 1 month to 2.5 years). Two late deaths (14%) occurred at 4 and 9 months. Four patients required additional interventional procedures on the left pulmonary artery after surgical repair.

Conclusions: Operations after PDA stenting are safe and low-risk. The presence of PDA stents requires additional surgical maneuvers on pulmonary arteries in near half of the patients, and postoperative interventions can be required.