Impact of previous left pulmonary artery stent on the outcome of a total cavopulmonary connection†.

Abstract

Objectives: This study aimed to investigate the impact of left pulmonary artery stenting on outcomes after Fontan procedure in patients with single ventricle physiology.

Methods: Patients who underwent staged Fontan palliation between 1994 and 2023 were reviewed. The records of patients who had left pulmonary artery stents implanted were analysed, and their impact on outcomes after Fontan completion was evaluated.

Results: Among 601 patients who underwent staged Fontan completion during the study period, 64 patients (10.6%) had a left pulmonary artery stent implanted (19 before Glenn and 49 before Fontan). Patients with a left pulmonary artery stent exhibited higher pulmonary artery pressure (10 vs 9 mmHg, P = 0.005) and smaller left pulmonary artery diameter (5.7 vs 6.6 mm, P = 0.002) before Fontan. The left pulmonary artery stenting group had longer cardiopulmonary bypass times (75 vs 62 min, P = 0.006) and a higher incidence of prolonged effusion (17.2% vs 9.5%, P = 0.049) at Fontan. Long-term follow-up revealed higher rates of reintervention of the left pulmonary artery (P = 0.001), plastic bronchitis (P = 0.007) and failing Fontan (P = 0.008) in the patients with left pulmonary artery stenting compared to those without. Hypoplastic left heart syndrome (odds ratio = 2.65, P = 0.008) and patent ductus arteriosus stenting (odds ratio = 4.03, P = 0.002) were identified as independent risk factors for the need for left pulmonary artery stenting.

Conclusions: A left pulmonary artery stent had been implanted in 10.6% of patients before Fontan completion. Left pulmonary artery stenting does not adversely affect survival but affects in-hospital morbidities and late morbidities of reintervention, plastic bronchiolitis, and failing Fontan.