Artery Shunt Research Articles

Prostate Artery Embolization: Challenges, Tips, Tricks, and Perspectives.

Prostatic artery embolization (PAE) consists of blocking the arteries supplying the prostate to treat benign prostate hypertrophia (BPH). Its effectiveness on both urinary symptoms and flowmetric parameters has now been amply demonstrated by around a hundred studies, including several randomized trials. The main advantage of this procedure is the very low rate of urinary and sexual sequelae, including ejaculatory, with an excellent tolerance profile. The arterial anatomy is a key element for the realization of PAE. Its knowledge makes it possible to anticipate obstacles and prevent potential complications related to nontarget embolization. Nontarget embolization can occur with a small intraprostatic shunt or reflux and has no consequences except some local inflammation symptoms that resolve in a couple of days. Nevertheless, some situations with large arterial shunts arising from the prostatic artery must be recognized (accessory rectal, bladder, or pudendal branches), and must imperatively be protected before embolization, at the risk of exposing oneself to otherwise ischemic complications that are more severe, such as bladder necrosis and skin or mucosal necrosis. This article offers a step-by-step review of the various anatomical and technical key points to ensure technical and clinical success, while avoiding the occurrence of adverse events.

Haemodynamic and clinical variables after surgical systemic to pulmonary artery shunt placement versus arterial ductal stenting.

Transcatheter stenting of the arterial duct is an alternative to surgical systemic to pulmonary artery shunt in neonates with parallel circulation. The current study compares haemodynamic and laboratory values in these patients for the first 48 hours after either intervention. Neonates with ductal dependent pulmonary blood flow who underwent surgical shunt placement or catheter-based arterial ductal stent placement between January 2013 and January 2022 were identified. Haemodynamic variables included heart rate, blood pressure, near infrared spectroscopy, central venous pressure, vasoactive inotropic score, and arterial saturation. Laboratory variables collected included blood urea nitrogen, serum creatinine, and serum lactate. Variables were collected at baseline, upon post-procedural admission, 6 hours after admission, 12 hours after admission, and 48 hours after admission. Secondary outcomes included post-procedural mechanical ventilation duration, post-procedural hospital length of stay, need for reintervention, need for extracorporeal membrane oxygenation, cardiac arrest, and inpatient mortality. Of the 52 patients included, 38 (73%) underwent shunt placement while 14 (27%) underwent a stent placement. Heart rates, renal oxygen extraction ratio, and cerebral oxygen extraction ratio were significantly lower in the stent group (p = <0.01, 0.01, and < 0.01, respectively).Haemoglobin and vasoactive inotropic scores were significantly lower in the stent group (p = <0.01, <0.01, respectively). The stent group had increased risk for cardiac arrest (p = 0.04). Patients who undergo arterial ductal stent placement have lower heart rates, haemoglobin, renal oxygen extraction ratio, cerebral oxygen extraction ratio, and vasoactive inotropic score in the first 48 hours post-procedure compared to patients with shunt placement.

Tricuspid atresia and common arterial trunk: a rare form of CHD.

Tricuspid atresia with common arterial trunk is a very rare association in complex CHD. This association has even more infrequently been documented concomitantly with interrupted aortic arch. We present the diagnosis and initial surgical management of an infant with a fetal diagnosis of tricuspid atresia and common arterial trunk, with additional postnatal finding of interrupted aortic arch with interruption between the left common carotid and left subclavian artery. Due to the infant's small size, she was initially palliated with bilateral pulmonary artery bands and a ductal stent. This was followed by septation of the common arterial trunk and interrupted aortic arch repair and 4 mm right subclavian artery to main pulmonary artery shunt placement at two months of age. She was discharged home on day of life 81.

Venous shunting and limb outcomes in military lower extremity combined arterial and venous injuries

Combined arterial and venous lower extremity (LE) injuries present complex management challenges. Temporary arterial shunting is widely accepted, but vein shunting is not well studied. We examined the influence of vein shunting on limb outcomes in military femoropopliteal arterial and venous combined injuries. A retrospective cohort study of Iraq and Afghanistan LE vascular injuries from 2004-2012 was performed and combined arterial and venous femoropopliteal injuries selected. Vein shunted and non-vein shunted groups were identified and pertinent variables compared. Of 135 arteriovenous injuries, 61 (45%) had vein ligation (5 after shunting), leaving 74 injuries undergoing venous repair (37 grafts (3 synthetic), 34 local repairs, 3 patches). The vein was shunted in 16 (22%). The shunt and no shunt cohorts had similar demographics, mechanism (70% blast), and ISS (median 18, IQR 10-26). Tourniquets and fasciotomy were used equally. Venous shunts were used almost exclusively in cases in which the artery was shunted (94% vs 22% no shunt, P<0.001) and more commonly in cases with bilateral LE vascular injuries (25% shunt vs 3.4% no shunt, P=0.01). Shunted veins more frequently underwent grafting (88% vs 40%, P<0.001). Median MESS was 8, IQR 7-9 in shunted vs. 6 (5-7) in unshunted limbs. Outcomes were similar, with amputation in 13% of shunted and 26% (P=0.33) unshunted and arterial repair complications in 44% and 28% (P=0.24). In combat casualties with combined arterial and venous femoropopliteal injury, vein shunting was used primarily in severely injured limbs in conjunction with arterial shunts and in injuries ultimately undergoing autologous grafting. Limb salvage was statistically equivalent with the use of venous shunts, suggesting equipoise in outcomes with and without venous shunting. Temporary venous shunting should be considered but does not appear to be mandatory in severe lower extremity combined arterial and venous injuries.

Cangrelor Dosing and Monitoring for Prevention of Acute Systemic-to-Pulmonary Artery Shunt Thrombosis in Neonates.

Systemic-to-pulmonary artery shunts are amongst the most common palliative procedures performed in neonates with congenital heart defects. These procedures require immediate postoperative thromboprophylaxis to prevent life-threatening shunt thrombosis. The novel use of intravenous P2Y12 platelet receptor antagonists has led to a need for dosing recommendations and monitoring. This study aims to determine cangrelor dosing in neonates through laboratory assessment of P2Y12 receptor reactivity and adverse events. Observational retrospective cohort study on the use of cangrelor for thromboprophylaxis in the immediate postoperative period of neonates undergoing placement of systemic-to-pulmonary artery shunts in a tertiary children's hospital from March 2020 to March 2021. Ten neonates receiving cangrelor post systemic-to-pulmonary artery shunt placement were included in the study. Median age and weight were 4 days (IQR, 2.75-5.25) and 3.49 kg (IQR, 3.1-3.75), respectively. Five (50%) patients received a 3.5-mm shunt, while the remaining patients received a 4-mm shunt. For thrombin inhibition, 5 (50%) patients received heparin and 5 (50%) received bivalirudin. Median cangrelor dose was 0.1 mcg/kg/min (IQR, 0.1-0.1). Median achieved P2Y12 reaction units (PRU) at this cangrelor dose was 127.5 (IQR, 72.5-173.75). No shunt thrombosis occurred in these patients; however, there was 1 minor hemorrhagic event. Our study suggests that a cangrelor dose of 0.1 mcg/kg/min is associated with therapeutic PRU and prevents shunt thrombosis in neonates post systemic-to-pulmonary artery shunt, with minimal hemorrhagic complications.

Abstract 14104: Trends and Associated Outcomes in Neonates With Ductal-Dependent Cyanotic Congenital Heart Disease Undergoing Surgical Systemic-Pulmonary Artery Shunts versus Catheter-Based Ductal Stents From the Pediatric Health Information System Database

Introduction: Neonates with ductal-dependent cyanotic congenital heart disease (CCHD) require palliation to establish stable pulmonary blood flow (PBF). Surgical systemic-to-pulmonary artery shunts have been the standard approach. More recently, catheter-based ductal stents have been performed as an alternative less invasive intervention. We aimed to characterize recent trends in the utilization of surgical shunts versus ductal stents and compare associated outcomes. Methods: Using data from the Pediatric Health Information System, we retrospectively analyzed neonates with CCHD who underwent surgical shunt or ductal stent placement to establish stable PBF between January 2016 and December 2021. Neonates with CCHD with ductal-dependent PBF were identified by ICD-10 diagnosis codes and stratified by surgical shunt or ductal stent using ICD-10 procedure codes. The primary outcome was post-intervention length of stay (LOS). Secondary outcomes were rate of reintervention on the ductal stent, surgical shunt, atrial septum, right ventricular outflow tract, or branch pulmonary arteries and adjusted hospital charges per admission. Results: Of the 931 patients included, 65.4% underwent a surgical shunt over the 5-year period. The proportion who underwent a ductal stent increased from 18.9% to 53.5% from 2016 to 2021. There was no significant difference in mortality (surgical shunt 6.1% vs ductal stent 4.4%, P=0.27). The median adjusted difference in LOS was 11 days greater for the surgical shunt cohort (95% CI: 8.5-13.5, P&lt;0.001). The likelihood of reintervention was significantly greater in the ductal stent group (30 days: adjusted OR=2.19, 95% CI: 1.02-4.71, P=0.044; 3 months: adjusted OR=4.85, 95% CI: 3.13-7.52, P&lt;0.011). Median adjusted total hospital charges were $572,400 (367,600-967,900) versus $302,500 (214,000-523,000) for the surgical shunt and ductal stent groups, respectively (P&lt;0.001). Conclusions: Ductal stenting has become an increasingly utilized palliative approach to secure PBF in neonates with CCHD across various centers in the United States. Ductal stenting is associated with decreased LOS and reduced overall charges for the index hospitalization but also with a greater reintervention rate than surgical shunting.

Derivaciones arteriales temporales en los programas de entrenamiento para los cirujanos generales.

The skills development to address vascular trauma by general surgeons is important in hospitals in countries with a lack of vascular surgeons, so we agree the implementation of training programs in vascular surgery basic techniques for general surgeons. In Peru, through an exploratory survey, 43 public hospitals have at least one vascular surgeon, of which 20 are located in Metropolitan Lima, and 14 of the 26 regions of Peru have at least one public institution with vascular surgery capabilities. We recommend the incorporation of the transient arterial shunt technique as an alternative to vascular anastomosis due to its security and feasibility for general surgeons training programs.

A natural systemic to pulmonary artery shunt.

Isolation of the left subclavian artery is a rare anomaly associated with right aortic arch. We report a case in which this subclavian artery was supplying the pulmonary circulation in a patient with tetralogy of Fallot (TOF) which effectively acted as a natural systemic to pulmonary artery shunt. The patient had good room air saturation and no features of vertebrobasilar insufficiency or left upper limb ischemia. She underwent a total correction of TOF and ligation of the aberrant left subclavian artery.

PLEURITIS AND EMPYEMA AFTER TRANSARTERIAL CHEMOEMBOLIZATION OF HEPATOCELLULAR CARCINOMA

PLEURITIS AND EMPYEMA AFTER TRANSARTERIAL CHEMOEMBOLIZATION OF HEPATOCELLULAR CARCINOMA

Brain Protection in Patients with Aortic Dissection and Coronary Artery Disease

The aim. To compare the effectiveness of methods of protecting the brain and visceral organs during operations for aortic aneurysms combined with coronary artery lesions.&#x0D; Materials and methods. In the period from 2012 to 2020, 23 patients with Stanford type A and non-A non-B aortic dissection with damage to the coronary arteries were operated at the National Amosov Institute of Cardiovascular Surgery of the NAMS of Ukraine using the brain protection techniques. Out of 23 surgical interventions, 16 were performed for Stanford type A acute aortic dissection, 3 for Stanford type A chronic aortic dissection, 1 for Stanford type A subacute aortic dissection, and 3 for Stanford non-A non-B aortic dissection. The main causes of aortic dissection were hypertension (16 patients), Marfan syndrome (3 patients), bicuspid aortic valve (4 patients).&#x0D; Results. The most threatening postoperative complication in this group of patients is neurological damage, which was observed in 4 (17%) patients after surgery, with gradual recovery of brain function. Also, the complications observed were respiratory failure in 3 (13%) patients, which required long-term artificial ventilation (more than 72 hours), and multiple organ failure in 1 (4.3%) patient, which caused a fatal outcome.Complications such as kidney and liver failure were not observed (most likely due to the small sample size). Heart failure was not noted as well. Hospital mortality was 4.3% (1 fatal case). In our study, among the entire group of operated patients, symptoms of neurological damage occurred in 4 (17.4%) patients, hemorrhagic stroke was present in 1 (4.3%) patient with a complicated medical history, 2 (8.6%) patients had hemiparesis and in 1 case (4.3%) there were cognitive disorders.&#x0D; Conclusions. Comparing brain protection techniques, taking into account the prolongation of aortic clamping time due to coronary artery shunting compared to isolated aortic dissection, it can be concluded that longer duration of selective brain perfusion (retrograde or antegrade) or duration of circulatory arrest more often lead to postoperative complications, namely neurological lesions.&#x0D; On the other hand, the small number of observations does not make it possible to fully assess the impact of each of the techniques. Further follow-up with a larger sample will provide opportunities for a more complete evaluation of brain protection techniques in operations for dissecting aortic aneurysms and coronary artery lesions.

Prediction of risk factors for intraoperative hypotension during general anesthesia undergoing carotid endarterectomy.

ObjectiveCarotid endarterectomy (CEA) has been considered as “gold standard” treatment for patients with significant carotid stenosis Intra-operative hypotension was a risk factor for post-operative complications in patients undergoing CEA. This study aimed to investigate the predictors for intra-operative hypotension during CEA.MethodsThis retrospective study included consecutive patients underwent CEA from June 1, 2020 to May 31, 2021 in the neurosurgery department of Xuanwu Hospital, Capital Medical University. The intraoperative hypotension was defined as blood pressure (BP) of 20% below standard value for longer than 5 min. Univariable and multivariable analyses were performed to identify the prediction of risk factors for intraoperative hypotension.ResultsOverall, 367 patients were included, and 143 (39.0%) patients had hypotension during CEA procedure. Univariate analysis indicated Grade 3 hypertension (P = 0.002), peripheral artery disease (P = 0.006) and shunting (P = 0.049) were associated with occurrence of intraoperative hypotension during CEA procedure. On multivariable analysis, Grade 3 hypertension (P = 0.005), peripheral artery disease (P = 0.009), and shunting (P = 0.034) were all found to be independent predicting factors of hypotension during the CEA process.ConclusionIntraoperative hypotension is a dynamic phenomenon may be affected by patients with grade 3 hypertension, peripheral artery disease and intra-operative shunting. It is necessary to pay special attention to these patients, both intraoperatively and postoperatively, to improve the final clinical outcome.

Hypoplastic Left Heart Syndrome: Definition, Morphology, and Classification.

This manuscript will provide information about hypoplastic left heart syndrome (HLHS) and related malformations, including definitions, morphology, and classification, based on the 2021 International Paediatric and Congenital Cardiac Code (IPCCC) and the Eleventh Revision of the International Classification of Diseases (ICD-11). HLHS is defined as "a spectrum of congenital cardiovascular malformations with normally aligned great arteries without a common atrioventricular junction, characterized by underdevelopment of the left heart with significant hypoplasia of the left ventricle including atresia, stenosis, or hypoplasia of the aortic or mitral valve, or both valves, and hypoplasia of the ascending aorta and aortic arch." Functionally univentricular heart is defined as "a spectrum of congenital cardiac malformations in which the ventricular mass may not readily lend itself to partitioning that commits one ventricular pump to the systemic circulation, and another to the pulmonary circulation." The Norwood operation is synonymous with the term "Norwood (Stage 1)" and is defined as (1) creation of an aortopulmonary connection and neoaortic arch construction resulting in univentricular physiology and (2) creation of a controlled source of pulmonary blood flow with a calibrated systemic-to-pulmonary artery shunt, a right ventricle to pulmonary artery conduit, or rarely, a cavopulmonary connection. The goals of the Norwood (Stage 1) Operation are creation of (1) unobstructed systemic blood flow via aortopulmonary connection and neoaortic arch construction, (2) unobstructed coronary blood flow, (3) unobstructed flow across the atrial septum, and (4) controlled pulmonary blood flow.

Long-term results after the REV (réparation à l’étage ventriculaire) procedure for malposition of the great arteries

Several surgical techniques can be used to repair anomalies of the ventriculoarterial connection with sub-pulmonary stenosis. Although there is no equivocal evidence that one technique is superior to another, the arterial switch operation (ASO) and Rastelli procedure are the preferred options to correct transposition of the great arteries (TGA) with ventricular septal defect (VSD) and left ventricular outflow tract obstruction (LVOTO). Despite innovative features and satisfactory short- and long-term results, the “réparation à l’étage ventriculaire” (REV) procedure has not gained large popularity and still struggles to establish itself as a legitimate alternative to the Rastelli operation. By describing our long-term results, we wish to address the misconceptions about the technical aspects and the long-term results of this technique that have been suggested to explain the reluctance towards it. Between 1980 and 2022, 157 patients underwent a REV procedure (median age and weight: 20.8 months and 7.7 kg). The most frequent anatomical presentation was the association between TGA, VSD and LVOTO ( n = 113, 72.0%). Sixty-seven patients (42.7%) underwent a Rashkind procedure, and 67 patients (42.7%) had a prior surgical palliation (including 62 systemic-to-pulmonary artery shunts). Resection of the conal septum and/or ventricular septal defect enlargement was performed in 65 patients (41.4%). Thirteen patients (8.3%) died, including 4 during the first postoperative month and 2 after heart transplant. Overall survival at 40 years was 89%. Thirty-seven patients (23.6%) required 67 reinterventions on the right ventricular outflow tract (RVOT), including 49 reoperations, with a median delay of 9 years after the REV (8 months – 27 years). Twenty patients (12.7%) underwent RVOT valvulation (16 surgical and 4 interventional). Freedom from RVOT reintervention and reoperation at 40 years were 60.3% and 62.6% respectively. Four patients (2.5%) required reoperation for left ventricular outflow tract obstruction, with a median delay of 4.8 years ( Fig. 1 ). The REV procedure is a good alternative to the Rastelli intervention when an arterial switch operation is not feasible. A quarter of the patients required redo surgery on the right ventricular outflow tract. Reoperations for left ventricular outflow tract obstruction are scarce.

Journey Toward Improved Long-Term Outcomes After Norwood-Sano Procedure: Focus on the Aortic Arch Reconstruction.

The disadvantage of right ventricle-to-pulmonary artery (RV-PA) shunt is the need for more unplanned interventions to address stenosis in the shunt or branch pulmonary arteries, as compared to the modified Blalock-Taussig shunt group. Ring-enforced RV-PA PTFE conduit and dunk technique minimized these complications and right ventricle (RV) damage. Aortic arch obstruction increases afterload and leads to ventricular dysfunction and tricuspid regurgitation; therefore, most surgeons prefer to use homograft, autologous pericardium, or bovine pericardium to reconstruct the neoaorta. Artificial materials decrease the elastic properties, increase wall stiffness, and decrease the distensibility of the aorta; and as a result, RV function gradually deteriorates. This inelastic reconstructed aorta may be one of the reasons why long-term outcomes after the Fontan procedure are worse in hypoplastic left heart syndrome (HLHS) patients, in comparison to non-HLHS. Reconstruction of the neoaorta without any patch materials, or at least techniques that largely minimize the use of non-autologous materials, will offer a further refinement of our ability to optimize ventriculoarterial coupling and thereby long-term RV function.

Use of a Composite Survival Curve to Optimise the Surgical Strategy for Double Inlet Left Ventricle

Objectives: Palliative surgery has improved the long-term survival of patients with Double inlet left ventricle (DILV). Neonates and infants with DILV presenting with reduced pulmonary blood flow (RPBF) are often offered a systemic arterial-to- pulmonary artery shunt (SAPAS). There is evidence that SAPAS in these patients, may not improve survival compared to the natural history. An objective assessment of the efficacy of a treatment requires a comparison of the treatment outcome with the natural history. Our aim was to review the literature to determine whether SAPASs in patients with DILV and RPBF improves survival compare to the natural history. Methods: We reviewed the literature and used the most externally valid data to create a composite survival curve that facilitates the comparison of surgical outcome and natural history. Results: The data suggests that SAPASs in patient with DILV and RBPF, may not improve long term survival compared to the natural history. There is also evidence that palliative surgery in general in patients older than 1 year of age with increased or balanced pulmonary blood flow may not improve survival compared to the natural history. Conclusions: SAPASs probably should not be offered to patients with DILV and RPBF. In addition, cardiac surgery probably should not be offered to patients with DILV presenting for the first time after 1 year of age.

50 Years Ago in TheJournalofPediatrics: Rare Conditions and Surgical Journeys

50 Years Ago in TheJournalofPediatrics: Rare Conditions and Surgical Journeys

Short- and medium-term outcomes for patent ductus arteriosus stenting in neonates ≤2.5 kg with duct-dependent pulmonary circulation.

Morbidity with surgical systemic-to-pulmonary artery shunting (SPS) in infants ≤2.5 kg has remained high. Patent ductus arteriosus (PDA) stenting may be a valid alternative. The objective of this study isto evaluate outcomes following PDA stenting in patients ≤2.5 kg from four large tertiary centers. Retrospective review of all neonates ≤2.5 kg with duct-dependent pulmonary circulation who underwent PDA stenting. Procedural details, pulmonary arterial growth, reinterventions, surgery type, and outcomes were assessed. PDA stents were implanted in 37 of 38 patients attempted (18 female) at a median procedural weight of 2.2 kg (interquartile range[IQR], 2-2.4 kg). Seven patients (18%) had a genetic abnormality and 16 (42%) had associated comorbidities. The median intensive care unit stay was 4 days (IQR, 2-6.75 days), and the median hospital stay was 20 days (IQR, 16-57.25). One patient required a rescue shunt procedure, with three others requiring early SPS (<30 days postprocedure). Twenty patients (54%) required reintervention with either balloon angioplasty, restenting, or both. At 6-month follow-up, right pulmonary artery growth (median z-score -1.16 to 0.01, p = 0.05) was greater than the left pulmonary artery (median z-score -0.9 to -0.64, p = 0.35). Serious adverse effects (SAEs) were seen in 18% (N = 7) of our cohort. One patient developed an SAE during planned reintervention There were no intraprocedural deaths, with one early procedure-related mortality, and three interstage mortalities not directly related to PDA stenting. PDA stenting in infants ≤2.5 kg is feasible and effective, promoting pulmonary artery growth. Reintervention rates are relatively high, though many are planned to allow for optimal growth before a definitive operation.

What are the benefits and harms of routine carotid artery shunting for adults undergoing carotid endarterectomy?

What are the benefits and harms of routine carotid artery shunting for adults undergoing carotid endarterectomy?

Modified cone procedure along with bidirectional cavopulmonary shunt for Ebstein anomaly in adult patients

Ebstein anomaly is an uncommon congenital cardiac disease affecting the tricuspid valve and right ventricle. Da silva pioneered the cone reconstruction of tricuspid valve for surgical repair of this anomaly in 2007. We describe our experience of 5 adult patients who underwent cone repair along with a bidirectional cavopulmonary shunt and tricuspid annuloplasty ring placement at our institute. Five adult patients with Ebstein anomaly with progressive disease and symptoms were taken up cone reconstruction from 2019 to 2021. Along with cone reconstruction of tricuspid valve, we routinely added an end to side superior vena cava to right pulmonary artery shunt and a tricuspid annuloplasty ring in the newly formed tricuspid annulus in all cases. All patients tolerated the procedure well and easily weaned off cardiopulmonary bypass. There were no complications regarding bidirectional cavopulmonary shunt and only one patient had a temporary heart block which was managed conservatively. This series shows routine addition of a cavopulmonary shunt and an annuloplasty ring improves outcomes and can be performed at other experienced cardiac surgery centres.

Decellularized vs Non-decellularized Allogeneic Pulmonary Artery Patches for Pulmonary Arterioplasty

We studied pulmonary artery size, reinterventions, and panel reactive antibodies in patients with single-ventricle physiology who underwent a pulmonary arterioplasty with decellularized (DAPAP) and non-decellularized allogeneic pulmonary artery patches (non-DAPAP). Retrospective review identified 59 patients with single-ventricle physiology who underwent pulmonary arterioplasty from 2008 to 2017: 28 patients underwent arterioplasty with DAPAP and 31 patients with non-DAPAP. Demographic and operative variables were similar between groups. Among patients who underwent a Norwood procedure, a right ventricle to pulmonary artery shunt was more commonly used in the DAPAP group (12/20, 60%) and a modified Blalock-Taussig shunt was more commonly used in the non-DAPAP group (17/22, 77%). On multivariable analysis, the use of DAPAP was associated with higher pre-Fontan angiography Z-scores in right (estimate = 0.17, standard error = 0.04, P=0.0005) and left pulmonary arteries (estimate = 0.12, standard error = 0.05, P=0.01). No areas of calcification, discrete coarctation, or pulmonary dilation were noted in any of the pulmonary arteries. On multivariable analysis, the use of DAPAP was associated with higher freedom from pulmonary artery reinterventions (Hazard ratio = 0.36, 95% confidence interval = 0.13-0.9, P = 0.04). The median value for Class I panel reactive antibodies was 0% (IQR 0, 4) in the DAPAP and 23% (IQR 14, 36) in the non-DAPAP group. The median value for Class II panel reactive antibodies was 15% (IQR 0, 17) in the DAPAP and 21% (IQR 10, 22) in the non-DAPAP group. Pulmonary arterioplasty with DAPAP was associated with higher pre-Fontan pulmonary artery Z-scores and higher freedom from pulmonary artery reinterventions.