Transcatheter Endovascular Bilateral Pulmonary Artery Banding and Ductal Stenting for High-Risk Hypoplastic Left Heart Syndrome and Neonatal Left Ventricular Failure

Background: Neonates with hypoplastic left heart syndrome with high-risk factors as well as neonates with left ventricular pump failure have a high mortality. Experience with transcatheter palliation is scarce.

Methods: After informed parental consent, transcatheter endovascular bilateral pulmonary artery banding (ebPAB) using perforated microvascular plugs and ductal stenting (DS) was performed in deep analgosedation or case of respiratory insufficiency after intubation in short-term ventilation (typically <8 h). Medication aiming at sparing oxygen consumption and facilitating ventricular reverse remodeling was established. LV failure was defined as severe dysfunction unable to sustain systemic circulation.

Results: Ten neonates (eight HLHS and two with neonatal LV failure) underwent transcatheter ebPAB and DS. Six of eight HLHS neonates (mean birth weight 2.9 kg, range 2.2–3.5 kg) had high-risk features (mean 2.3, range 1–5). LV failure was due to fetal COVID-19 infection (one patient) and is still present despite moderate improvement after fetal valvuloplasty for critical aortic stenosis (one patient). Transcatheter interventions were uneventful in all 10 patients. In two HLHS patients, a highly restrictive interatrial septum was perforated with RF energy and stented with a ballon-expandable stent. Deferred Norwood followed by a Glenn procedure was performed in two HLHS patients with severely hypoplastic aorta (<2 mm). Comprehensive stage 2 (CS2) was uneventfully performed in five HLHS patients, whereas in one HLHS patient with bilateral superior vena cava, the patient succumbed in succession to a thrombosis of the left pulmonary artery. One HLHS patient is awaiting CS2. A Ross procedure was performed in the patient s/p fetal aortic valvuloplasty after full recovery of LV function at the age of 8 months. Heart transplantation was performed in a patient with fetal COVID-19 infection at the age of 21 months in a different hospital. The clinical condition, hemodynamics, and neurological outcome of all nine survivors are good and unimpaired, respectively.

Conclusion: Transcatheter ebPAB and DS for high-risk HLHS and neonatal left ventricular failure is feasible, safe, and appears to be a strategy to improve outcomes.

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Artikel online veröffentlicht:
11. Februar 2025