128. Does Perioperative Left Pulmonary Artery Stenting during Comprehensive Stage 2 Procedure Impact Fontan Candidacy?

Objective: Our center has adopted and refined the hybrid strategy for Hypoplastic Left Heart Syndrome (HLHS) and variants utilizing several pulmonary artery reconstructive techniques during the Comprehensive Stage 2 (CS2) procedure. Since 2017 planned, preemptive left pulmonary artery (LPA) stenting has been employed. We hypothesized that LPA stenting promotes adequate growth and does not negatively impact Fontan candidacy. Thus, in this single-center retrospective cohort study, we report our initial clinical experience with preemptive LPA stenting during CS2.

Methods: From 2002 to 2020, 159 patients underwent Hybrid Stage 1 (HS1) palliation followed by CS2 procedure. Patients were divided into two groups: those who did not receive a perioperative LPA stent (n=122, Group 1) and those who did (n=37, Group 2). Within the latter, a subgroup of patients had unplanned stent placement prior to discharge following CS2 (n=17, Group 2a) or received planned, preemptive stenting during the conduct of CS2 (n=20, Group 2b). Besides demographic and perioperative data, distal and lobar LPA dimensions from angiography were reviewed and compared between these groups. Data were analyzed using non-parametric statistics.

Results: Median patient age and weight at the time of CS2 and hospital length of stay after CS2 did not differ between Groups 1 & 2 (1: 5.37 vs 2: 5.65 months, p = 0.3421; 6.2 vs. 6.1 kg, p = 0.254; 11 vs 10 days, p=0.186, respectively). Median cardiopulmonary bypass and crossclamp times were significantly greater in Group 1 (265 vs 243 min, p=0.021; 46 vs 26 min, p=0.008). In-hospital/30-day mortality was similar between groups (1: 12/122, 9.84% vs 2: 6/37, 16.21%, p=0.283). Group 2b demonstrated a superior survival compared to Group 2a (p=0.004) but not Group 1 (p=0.143). Preemptive pulmonary stenting significantly increased median distal LPA diameter at the time of CS2 exit angiogram compared to no stenting at all (p<0.0001). Both Groups 2a and 2b significantly increased the pre-Fontan diameter of the distal LPA when compared to Group 1 (6.1 and 6.8 vs 5.7mm, respectively, p<0.0001). In the interstage period, balloon angioplasty was the most common intervention, whereas the incidence of interventions for Groups 1 & 2 was similar (21 vs 22%). A total of 113 patients have achieved a Fontan circulation (71%). Median follow-up time for Groups 1 and 2 were 6.6 and 3.0 years, respectively.

Conclusions: Comparison of CS2 exit and pre-Fontan angiograms provided insights into the consequences of perioperative LPA stenting with regards to pulmonary growth during the interstage period. Perioperative LPA stenting does not adversely affect pulmonary growth. Preemptive stenting is advantageous for LPA growth in preparation for Fontan completion. Ongoing work will elucidate the long-term effects of perioperative LPA stenting on post-Fontan pulmonary artery growth and remodeling.

sergio carrillo (1), Cameron Best (1), Diane Hersey (1), Karen Texter (1), Brian Boe (1), Patrick McConnell (1), Mark Galantowicz (1), (1) Nationwide Children's Hospital, Columbus, OH

James Hammel

Invited Discussant

Congenital heart surgeon at the Betz Congenital Heart Center at Helen DeVos Children's Hospital, Grand Rapids, Michigan.

sergio carrillo

Abstract Presenter

Born and raised in Guatemala. Enrolled in Medical School where I had the one-in-a-lifetime opportunity to meet and be mentored by Aldo Castañeda, MD PhD (74th AATS president) in a carreer in Cardiothoracic Surgery. Completed General Surgery Residency at the Univerisity of Louisville, Louisville, Kentucky followed by Fellowship in Thoracic Surgery at The Ohio State University and Nationwide Children's Hospital, Columbus, Ohio. Spent another 2 years under the tutelage of Aldo Castañeda in Guatemala, focused in Congenital Heart Surgery followed by Congenital Heart Surgery training at Lucile Packard Children's Hospital at Stanford University, Palo Alto, California. Began my Congenital Heart Surgery career at the only pediatric and congenital center in the state of Nevada, Children's Heart Center, Nevada and Sunrise Children's Hospital, both in Las Vegas, Nevada where I held the position of Assistant Professor of Surgery at the University of Nevada - Las Vegas. Was recruited back to Nationwide Children's Hospital and The Ohio State University in 2018 by another mentor of mine, Mark Galantowicz, MD. My clinical interest lay in Single ventricle anatomy, physiology and palliation, Neonatal Heart Surgery and pulmonary artery reconstructive techniques including unifocalization. My research focuses on recapitulating the long-term effects of the Fontan Physiololgy in a large animal model, as well as, tissue-engineered vascular grafts for use during Congenital Heart Surgery.

 

Specialties: Congenital, Anatomy and Conditions, Hypoplastic Left Heart Syndrome, Single Ventricle, Treatment/Procedure/Operation/Surgery, Hybrid Palliation