Abstract
Background
Transcatheter ductus arteriosus stenting (DS) is emerging as an alternative method to modified Blalock–Taussig shunt (MBTS) in providing pulmonary blood flow in cyanotic congenital heart disease (CCHD) with duct-dependent pulmonary circulation.
Objective
To evaluate post-procedural outcomes and survival between patients undergoing DS and MBTS.
Methods
All infants ≤ 60 days of age having CCHD with diminished pulmonary blood flow who underwent palliative procedure either with MBTS or DS at King Chulalongkorn Memorial Hospital during January 1st, 2013 and December 31th, 2017 were retrospectively reviewed.
Results
98 patients were included; 34 patients underwent a transcatheter DS and 64 patients underwent MBTS. There was no significant difference in post-procedural outcomes and overall mortality rate between two groups (17.6% in MBTS group and 6.1% in DS group, p = 0.09). Single ventricle morphology was the major risk factor associated with increased mortality compared with biventricular morphology (aHR 3.9, 95% CI 1.49–10.2, p = 0.01). There was similar number of early and pre-repair additional interventions focusing on MBTS/DS patency between two groups. The MBTS group had a greater number of early interventions on PA branch stenosis related to baseline diagnosis. Risk factors associated with additional intervention were pre-existing pulmonary branch stenosis (aHR 2.54, 95% CI 1.3–4.97, p = 0.006) and body weight less than 2.5 kg (aHR 3.33, 95% CI 1.57–7.08, p = 0.003). Having pulmonic valve perforation or balloon pulmonary valvuloplasty to promote antegrade pulmonary blood flow could result in a lower number of additional interventions required before definitive repair.
Conclusion
Duct stenting is a feasible and safe alternative to MBTS in cyanotic infants with duct-dependent pulmonary circulation. However, mortality rate was significantly higher in patients with single ventricle that required careful follow-up after procedure.
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References
Blalock A, Taussig HB (1984) Landmark article May 19, 1945: the surgical treatment of malformations of the heart in which there is pulmonary stenosis or pulmonary atresia: by Alfred Blalock and Helen B. Taussig. JAMA 251:2123–2138
Williams JA, Bansal AK, Kim BJ, Nwakanma LU, Patel ND, Seth AK, Alejo DE, Gott VL, Vricella LA, Baumgartner WA, Cameron DE (2007) Two thousand Blalock–Taussig shunts: a six-decade experience. Ann Thorac Surg 84:2070–2075
Dorobantu DM, Pandey R, Sharabiani MT, Mahani AS, Angelini GD, Martin RP, Stoica SC (2016) Indications and results of systemic to pulmonary shunts: results from a national database. Eur J Cardiothorac Surg 49:1553–1563
Ahmad U, Fatimi S, Naqvi I, Atiq M, Moizuddin SS, Sheikha KB, Shahbuddin S, Naseem TM, Javed MA (2008) Modified Blalock-Taussig shunt: immediate and short-term follow-up results in neonates. Heart Lung Circ 17:54–58
Gibbs JL, Rothman MT, Rees MR, Parsons JM, Blackburn ME, Ruiz CE (1992) Stenting of the arterial duct: a new approach to palliation for pulmonary atresia. Br Heart J 67:240–245
Santoro G, Gaio G, Palladino M (2008) Stenting of the arterial duct in newborns with duct-dependent pulmonary circulation. Heart 94:925–929
Michel-Behnke I, Akintuerk H, Thul J (2004) Stent implantation in the ductus arteriosus for pulmonary blood supply in congenital heart disease. Catheter Cardiovasc Interv 61:242–252
Alwi M, Choo KK, Latiff HA, Kandavello G, Samion H, Mulyadi MD (2004) Initial results and medium-term follow-up of stent implantation of patent ductus arteriosus in duct-dependent pulmonary circulation. J Am Coll Cardiol 44:438–445
Erdem A, Karaci AR, Sarita T, Akdeniz C, Demir H, Sasmazel A, Celebi A (2011) Evaluation of the efficacy of ductus arteriosus stenting in neonates and infants with severe cyanosis until the later stage palliative surgery or total repair time. Turk Gogus Kalp Damar Cerrahisi Derg 19:192–196
O’Connor MJ, Ravishankar C, Ballweg JA, Gillespie MJ, Gaynor JW, Tabbutt S, Domingue TE (2011) Early systemic-to-pulmonary artery shunt intervention in neonates with congenital heart disease. J Thorac Cardiovasc Surg 142:106–112
Bentham JR, Zava NK, Harrison WJ, Shauq A, Kalantre A, Derrick G, Chen RH, Dhillon R, Taliotis D, Sl K, Crossland D, Adesokan A, Hermuzi A, Yong S, Noonan P, Hayes N, Stumper O, Thomson JDR (2018) Duct stenting versus modified Blalock-Taussig shunt in neonates with duct-dependent pulmonary blood flow: associations with clinical outcomes in a multicenter national study. Circulation 137:581–588
Glatz A, Petit C, Goldstein B, Kelleman MS, McCracken CE, McDonnell AM, Buckey T, Mascio CE, Shashidharan S, Ligon RA, Ao J, Whiteside W, Wallen WJ, Metcalf CM, Aggarwal V, Agrawal H, Qureshi AM (2018) Comparison between patent ductus arteriosus stent and modified Blalock-Taussig shunt as palliation for infants with ductal-dependent pulmonary blood flow. Circulation 137:589–601
Mallula K, Vaughn G, El-Said H, Lamberti JJ, Moore JW (2015) Comparison of ductal stenting versus surgical shunts for palliation of patients with pulmonary atresia and intact ventricular septum. Catheter Cardiovasc Interv 85:1196–1202
McMullan D, Permut L, Jones T (2014) Modified Blalock-Taussig shunt versus ductal stenting for palliation of cardiac lesions with inadequate pulmonary blood flow. J Thorac Cardiovasc Surg 147:397–403
Vigo CM, Pinedo GM, Mondragón CS, Montes ML, Manrique SA, Bejarano GH, Chunga EE (2015) Immediate and medium-term outcomes of ductal stenting in neonates and infants. Rev Bras Cardiol Invas 23:211–215
Matter M, Almarsafawey H, Hafez M, Attia G, Abuelkheir MM (2012) Patent Ductus arteriosus stenting in complex congenital heart disease: early and midterm results for a single-center experience at Children Hospital, Mansoura, Egypt. Pediatr Cardiol 34:1100–1106
Petrucci O, O’Brien SM, Jacobs ML, Jacobs JP, Manning PB, Eghtesady P (2011) Risk factors for mortality and morbidity after the neonatal Blalock-Taussig Shunt procedure. Ann Thorac Surg 92:642–652
Myers JW, Ghanayem NS, Cao Y, Simpson P, Trapp K, Mitchell ME, Tweddell JS, Woods RK (2014) Outcomes of systemic to pulmonary artery shunts in patients weighing less than 3 kg: analysis of shunt type, size, and surgical approach. J Thorac Cardiovasc Surg 147:672–677
Djer M, Madiyono B, Sastroasmoro S, Putra S (2016) Stent implantation into ductus arteriosus: a new alternative of palliative treatment of duct-dependent pulmonary circulation. Paediatr Indones 44:30–36
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Lekchuensakul, S., Somanandana, R., Namchaisiri, J. et al. Outcomes of duct stenting and modified Blalock–Taussig shunt in cyanotic congenital heart disease with duct-dependent pulmonary circulation. Heart Vessels 37, 875–883 (2022). https://doi.org/10.1007/s00380-021-01978-w
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DOI: https://doi.org/10.1007/s00380-021-01978-w