# Comparison of outcomes following the Fontan procedure between patients with previous ductus stent and aortopulmonary shunt

## TL;DR

The study found that outcomes after a heart procedure called the Fontan procedure are similar in patients who had either a ductus stent or a surgical shunt as initial treatments.

## Contribution

This study is the first to compare long-term outcomes of the Fontan procedure in patients with different initial palliative treatments.

## Key findings

- Patients with ductus stenting had a higher incidence of venovenous collaterals compared to those with aortopulmonary shunts.
- There was no significant difference in mortality, hospital stay duration, or freedom from reintervention between the two groups.
- Outcomes following the Fontan procedure were comparable between the two initial treatment groups.

## Abstract

In this study, we aimed to compare the outcome after the Fontan procedure in patients after an initial ductus stenting or a surgical aortopulmonary shunt.

We reviewed infants with single ventricle and ductal-dependent pulmonary blood flow who underwent ductus stenting or an aortopulmonary shunt between 2009 and 2022, and subsequently underwent the staged Fontan procedure.

A total of 93 patients were included (39 ductus stenting and 54 aortopulmonary shunts). Before the Fontan procedure, pulmonary artery pressure (9 vs 9 mmHg, P = 0.376) and pulmonary artery index (184 vs 183 mm2/m2, P = 0.988) were similar between the groups. However, the incidence of venovenous collaterals was higher in patients after ductus stenting than those after aortopulmonary shunt (35.9 vs 16.7%, P = 0.034). Median age (1.9 vs 1.8 years, P = 0.493) and weight at the Fontan procedure (12 vs 11 kg, P = 0.596) were similar between the groups. There was no in-hospital mortality in each group. The length of the intensive care unit stay (median 5 vs 5 days, P = 0.542) and hospital stay (median 17 vs 14 days, P = 0.767) were similar between the groups. During the median follow-up of 2.5 years, one late death was observed in the ductal stenting group. Freedom from reintervention (66.6 vs 82.0%, P = 0.095) and from adverse events (78.6 vs 92.2%, P = 0.488) at 5 years were similar between the groups.

This pilot study demonstrated comparable outcomes following the Fontan procedures between patients with single ventricle and ductal-dependent pulmonary blood flow after initial ductus stenting and those after initial aortopulmonary shunt.

In neonates with single ventricle and patent ductus arteriosus (PDA)-dependent pulmonary circulation, ductal stenting (DS) emerged as an alternative to aortopulmonary shunt (APS) [1, 2].