Surgical Management After Patent Ductus Arteriosus Stenting for Ductal-Dependent Pulmonary Circulation: A Review of Techniques, Pulmonary Artery Reconstruction, and Outcomes

Background: Patent ductus arteriosus (PDA) stenting is an established alternative pal-liative strategy to surgical shunts for infants with duct-dependent pulmonary circulation. Subsequent definitive or staged surgical repair is typically required, presenting unique challenges to the indwelling stent and pulmonary artery (PA) integrity. Reports on the ease of stent management and the necessity for PA reconstruction vary. This review synthesizes the available evidence on surgical techniques, PA management strategies, and outcomes following PDA stenting. Methods: A literature search was conducted across PubMed/MEDLINE, Embase, Scopus, Web of Science, and Cochrane Library databases. Studies reporting on surgical man-agement and outcomes after previous PDA stenting in patients with duct-dependent pulmonary circulation were included. Data on surgical timing, stent management techniques, PA reconstruction methods, complications, PA outcomes, and mortality were extracted. Results: Techniques for stent management varied, including complete removal, partial removal/transection, and incorporation. Conflicting reports exist regarding the difficulty of stent removal, with some studies noting significant adhesion and need for partial removal, while others describe straightforward removal or transection. Pulmonary artery reconstruction (plasty/patching) was frequently required, often involving the left PA. Surgical mortality was reported but generally considered low. Postoperative PA stenosis requiring reintervention remains a concern. Conclusions: Surgical intervention after PDA stenting is feasible but necessitates specific strategies for managing the indwelling stent and associated pulmonary arteries. PA reconstruction is common, highlighting the impact of the stented ductus on adjacent vascular structures. Discrepancies regarding stent removal difficulty warrant further investigation, potentially related to stent type, duration, or evolving surgical experience.