Transaxillary access for PDA Stenting in Neonates with Duct-Dependent Cyanotic Congenital Heart: A Retrospective Study
Authors: Amr Shaher Ahmed Almomani  , Ade Fahmi Almomanie  , Mohammad Harbi Khassawneh  , Qais Khalil Jamil Alqusus  , Ali Hussein Alkhazaleh  
Published: November 2024

Background: Duct-dependent cyanotic congenital heart is a critical heart disease in infants. In neonates, patients with obstructing native ductus arteriosus may need palliative stenting to maintain adequate blood flow during the transition period. These babies are similar to ductal-dependent lesions but require patent ductus arteriosus (PDA) flow for their transition from fetal to neonatal circulation. PDA stenting is a well-recognized palliative for duct-dependent cyanotic congenital heart in neonates. Objectives: The study highlights the clinical utilities of transaxillary access for PDA stenting in neonates with duct-dependent cyanotic congenital heart Methods: The study aimed to evaluate the effectiveness of transaxillary access for direct stenting and stent placement in neonates with stable duct-dependent congenital heart disease and cyanosis due to non-obstructive arterial duct. The study involved a retrospective approach, using existing data and focusing on acute interventional procedure success with transaxillary access. Secondary endpoints included successful weaning from access to surgical conduit, cannula removal, antegrade flow reduction if connected to BDG, need and success rate of transaxillary plug insertion, and major and minor complications associated with AXA. The study design allowed for a comprehensive evaluation of the feasibility of this technique and its potential benefits and drawbacks. Data was collected from electronic medical records, Picture Archiving and Communication System, and the electronic database of the Intensive Care Unit of a hospital between 2016 and 2021. The study aimed to evaluate the risk-benefit of performing DDC in neonates through the AS in a new cohort of patients in the future. Results: This retrospective study examined the management of cyanotic congenital heart disease in 36 neonates, with eight cases involving elbow neoaortic utilization and 28 having a PDA diameter less than 1 mm. In seven cases, a 4-Fr angiographic pigtail was inserted retrograde to image the PDA, which was then accessed by navigating a 4-Fr JB1 catheter from the cannulation site. A portable X-ray unit was used exclusively to position these catheters and wires during the procedures under C-arm guidance. Diagnostic catheter removals were managed differently in this study, following the same principles used for sheath extractions in 29 retrospective and prospective presentations. The study reported on the procedural outcomes for transaxillary access and PDA stenting in neonates with duct-dependent cyanotic congenital heart disease. The study found no specific demographic or additional pre-procedural risk factors that would affect the results of the study. Conclusion: Transaxillary PDA stenting is a safe method for treating duct-dependent hypoxic congenital hearts in neonates, but has limitations like limited use, long transcatheter treatment periods, and anesthesia risks. It's recommended for developing countries with limited access to advanced care. The study improved palliative PDA stenting standard in CCTGA patients with complex congenital heart disease. Recommendations include insertion of a transaxillary sheath, support, and arterial access under ultrasound guidance.