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Hybrid stenting of the arterial duct with carotid cutdown and flip technique: immediate and early results

Part of: Interventional Cardiology

Published online by Cambridge University Press:  11 October 2021

Supratim Sen Open the ORCID record for Supratim Sen [Opens in a new window] ,
Priya Pradhan ,
Sneha Jain Open the ORCID record for Sneha Jain [Opens in a new window] ,
Dipesh Trivedi  and
Pradeep Kaushik
Supratim Sen*
Affiliation:
Department of Pediatric Cardiology, SRCC Children’s Hospital, Mumbai, India
Priya Pradhan
Affiliation:
Department of Pediatric Cardiology, SRCC Children’s Hospital, Mumbai, India
Sneha Jain
Affiliation:
Department of Pediatric Cardiology, SRCC Children’s Hospital, Mumbai, India
Dipesh Trivedi
Affiliation:
Department of Pediatric Cardiac Surgery, SRCC Children’s Hospital, Mumbai, India
Pradeep Kaushik
Affiliation:
Department of Pediatric Cardiac Surgery, SRCC Children’s Hospital, Mumbai, India
*
Author for correspondence: Dr S. Sen, Department of Pediatric Cardiology, SRCC Children’s Hospital, Mahalaxmi, Mumbai400050, India. E-mail: supratim80@gmail.com
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Abstract

Stenting of the arterial duct (PDA) has become a standard palliation for ductal-dependent pulmonary circulation. Carotid arterial access provides a direct route for stenting vertical ducts. We evaluated our early results of hybrid ductal stenting via surgical carotid cutdown.

Methods and results:

In this retrospective single centre cohort study, hybrid PDA stenting was attempted in 11 patients with “flip technique”, between January 2020 and February 2021, and was successful in 10. Median age was 29 days (interquartile range 17.5–87) and mean weight 3.37 ± 1.23 kg. Mean fluoroscopy time was 13.58 ± 5.35 minutes, mean procedure time was 48.50 ± 22.5 minutes, and mean radiation dose was 1719.5 ± 1217.6 mGycm2. Mean time for cutdown was 9.9 ± 2.4 minutes and for haemostasis and suturing was 25.3 ± 11.0 minutes. Median duration of ventilation post-stenting was 26 hours (interquartile range 21–43.75). The median ICU stay post-procedure was 5 days (interquartile range 4–7.25) and mean hospital stay was 12 ± 6.3 days. On early follow-up, carotid patency was confirmed in all patients with colour Doppler, with no intravascular thrombi, narrowing, haematomas, or aneurysms noted. There were no complications secondary to vascular access. There was one early mortality, 27 days post-stenting, which was unrelated to the procedure.

Conclusion:

This study adds to the limited literature on ductal stenting with carotid access and the flip technique. In our early experience, the hybrid carotid approach is an attractive alternative to percutaneous carotid puncture and has simplified a complex and challenging intervention, with good outcomes.

Keywords

PDA stentingcarotid cutdownpulmonary atresianeonatal interventions
Type
Original Article
Information
Cardiology in the Young , Volume 32 , Issue 8 , August 2022 , pp. 1254 - 1260
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Copyright
© The Author(s), 2021. Published by Cambridge University Press

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